Healthcare Provider Details

I. General information

NPI: 1023356052
Provider Name (Legal Business Name): JEAN-GILLES TCHABO MD LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2013
Last Update Date: 01/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5275 LEE HWY SUITE G-1
ARLINGTON VA
22207-1619
US

IV. Provider business mailing address

5275 LEE HWY SUITE G-1
ARLINGTON VA
22207-1619
US

V. Phone/Fax

Practice location:
  • Phone: 703-558-6591
  • Fax: 703-558-6496
Mailing address:
  • Phone: 703-558-6591
  • Fax: 703-558-6496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JEAN GILLES TCHABO
Title or Position: PRESIDENT
Credential: M.D.
Phone: 703-558-6591