Healthcare Provider Details

I. General information

NPI: 1659482412
Provider Name (Legal Business Name): KATHLEEN MARY LINK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 02/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8505 ARLINGTON BLVD SUITE # 100
FAIRFAX VA
22031-4621
US

IV. Provider business mailing address

8505 ARLINGTON BLVD SUITE # 100
FAIRFAX VA
22031-4621
US

V. Phone/Fax

Practice location:
  • Phone: 703-970-2600
  • Fax: 703-970-6599
Mailing address:
  • Phone: 703-970-2600
  • Fax: 703-970-6599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number0101031311
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: