Healthcare Provider Details

I. General information

NPI: 1154558195
Provider Name (Legal Business Name): PRIYA GOWDA-BOYLAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2009
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43480 YUKON DR STE 206
ASHBURN VA
20147-7335
US

IV. Provider business mailing address

43480 YUKON DR STE 206
ASHBURN VA
20147-7335
US

V. Phone/Fax

Practice location:
  • Phone: 703-359-5100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0116021501
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: