Healthcare Provider Details

I. General information

NPI: 1912432022
Provider Name (Legal Business Name): JAMES AUSTIN UNDERWOOD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2017
Last Update Date: 11/17/2022
Certification Date: 11/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25055 RIDING PLZ STE 260
CHANTILLY VA
20152-5922
US

IV. Provider business mailing address

21475 RIDGETOP CIR STE 150
STERLING VA
20166-6580
US

V. Phone/Fax

Practice location:
  • Phone: 703-272-5000
  • Fax: 703-957-3804
Mailing address:
  • Phone: 703-444-5000
  • Fax: 703-444-5000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License Number0101274225
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: