Healthcare Provider Details

I. General information

NPI: 1366444697
Provider Name (Legal Business Name): DEPAK SONI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2005
Last Update Date: 11/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3650 JOSEPH SIEWICK DR STE 307
FAIRFAX VA
22033-1715
US

IV. Provider business mailing address

3650 JOSEPH SIEWICK DR STE 307
FAIRFAX VA
22033-1715
US

V. Phone/Fax

Practice location:
  • Phone: 703-391-8804
  • Fax: 703-391-5659
Mailing address:
  • Phone: 703-391-8804
  • Fax: 703-391-5659

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number0101046407
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number0101046407
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: