Healthcare Provider Details

I. General information

NPI: 1114832102
Provider Name (Legal Business Name): LAUREL HEALTH TECHNOLOGIES, CO.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22933 EMERALD CHASE PL
BRAMBLETON VA
20148-6446
US

IV. Provider business mailing address

22933 EMERALD CHASE PL
BRAMBLETON VA
20148-6446
US

V. Phone/Fax

Practice location:
  • Phone: 703-687-7869
  • Fax:
Mailing address:
  • Phone: 703-687-7869
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. RAHUL KUMAR
Title or Position: CEO
Credential:
Phone: 703-687-7869