Healthcare Provider Details

I. General information

NPI: 1265344881
Provider Name (Legal Business Name): POET MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2026
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23710 SCHOOLER PLZ STE 2023
ASHBURN VA
20148-1920
US

IV. Provider business mailing address

23710 SCHOOLER PLZ STE 2023
ASHBURN VA
20148-1920
US

V. Phone/Fax

Practice location:
  • Phone: 124-062-6792
  • Fax:
Mailing address:
  • Phone: 124-062-6792
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: NYSA MARINDA PAYSOUR
Title or Position: OWNER
Credential:
Phone: 124-062-6792