Healthcare Provider Details

I. General information

NPI: 1902160310
Provider Name (Legal Business Name): DONGLI HUANG PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2012
Last Update Date: 06/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14225 NEWBROOK DR
CHANTILLY VA
20151-2228
US

IV. Provider business mailing address

14225 NEWBROOK DR
CHANTILLY VA
20151-2228
US

V. Phone/Fax

Practice location:
  • Phone: 703-802-7085
  • Fax: 703-802-7103
Mailing address:
  • Phone: 703-802-7085
  • Fax: 703-802-7103

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170100000X
TaxonomyPh.D. Medical Genetics
License Number2011080
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code170100000X
TaxonomyPh.D. Medical Genetics
License Number2011081
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: