Healthcare Provider Details

I. General information

NPI: 1184627903
Provider Name (Legal Business Name): DIANE E. DUBINSKY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 10/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3650 JOSEPH SIEWICK DR STE 101
FAIRFAX VA
22033-1700
US

IV. Provider business mailing address

3650 JOSEPH SIEWICK DR STE 101
FAIRFAX VA
22033-1700
US

V. Phone/Fax

Practice location:
  • Phone: 703-391-0900
  • Fax: 703-391-2919
Mailing address:
  • Phone: 703-391-0900
  • Fax: 703-391-2919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101036379
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: