Healthcare Provider Details

I. General information

NPI: 1679917041
Provider Name (Legal Business Name): LAUREN ELIZABETH DEAHL DVM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2013
Last Update Date: 04/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8500 ARLINGTON BLVD
FAIRFAX VA
22031-4604
US

IV. Provider business mailing address

2605 YOUNGS DR
HAYMARKET VA
20169-1646
US

V. Phone/Fax

Practice location:
  • Phone: 703-752-9100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174M00000X
TaxonomyVeterinarian
License Number0301203283
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: