Healthcare Provider Details

I. General information

NPI: 1376766816
Provider Name (Legal Business Name): JOHN PHILLIP ESSEPIAN III M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 02/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3031 JAVIER RD STE 300
FAIRFAX VA
22031-4638
US

IV. Provider business mailing address

3031 JAVIER RD STE 300
FAIRFAX VA
22031-4637
US

V. Phone/Fax

Practice location:
  • Phone: 703-698-8880
  • Fax: 703-698-8884
Mailing address:
  • Phone: 703-698-8880
  • Fax: 703-698-8884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207WX0009X
TaxonomyGlaucoma Specialist (Ophthalmology) Physician
License Number0101051247
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number0101051247
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: