Healthcare Provider Details

I. General information

NPI: 1447404942
Provider Name (Legal Business Name): MIRASLAVA KHMURETS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2008
Last Update Date: 10/02/2023
Certification Date: 10/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 N GLEBE RD STE 525
ARLINGTON VA
22201-5792
US

IV. Provider business mailing address

6244 TALIAFERRO WAY
ALEXANDRIA VA
22315-3705
US

V. Phone/Fax

Practice location:
  • Phone: 804-207-6737
  • Fax:
Mailing address:
  • Phone: 703-994-1119
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD038394
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0101250913
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: