Healthcare Provider Details

I. General information

NPI: 1053230649
Provider Name (Legal Business Name): PATRICK TUBBINS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5641 BURKE CENTRE PKWY
BURKE VA
22015-2259
US

IV. Provider business mailing address

5433 CROWS NEST CT
FAIRFAX VA
22032-3302
US

V. Phone/Fax

Practice location:
  • Phone: 703-390-1182
  • Fax: 844-269-1569
Mailing address:
  • Phone: 504-957-4670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number07001006582
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: