Healthcare Provider Details

I. General information

NPI: 1114244084
Provider Name (Legal Business Name): JONATHAN ARI CABIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2010
Last Update Date: 07/05/2021
Certification Date: 07/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1525 WILSON BLVD STE 125
ARLINGTON VA
22209-2470
US

IV. Provider business mailing address

1525 WILSON BLVD STE 125
ARLINGTON VA
22209-2470
US

V. Phone/Fax

Practice location:
  • Phone: 703-214-6496
  • Fax: 844-357-7049
Mailing address:
  • Phone: 703-214-6496
  • Fax: 844-357-7049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License NumberMD048906
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number261903
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License NumberA135174
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License NumberD0090838
License Number StateMD
# 5
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number0101271072
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: