Healthcare Provider Details

I. General information

NPI: 1295515773
Provider Name (Legal Business Name): AUTISM PATH 2 CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2023
Last Update Date: 10/03/2023
Certification Date: 10/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 WILSON BLVD SUITE 700 #1055
ARLINGTON VA
22201
US

IV. Provider business mailing address

2300 WILSON BLVD SUITE 700 #1055
ARLINGTON VA
22201
US

V. Phone/Fax

Practice location:
  • Phone: 866-460-5686
  • Fax:
Mailing address:
  • Phone: 866-460-5686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: RANDALL LEE
Title or Position: MEMBER
Credential: MD
Phone: 917-608-6388