Healthcare Provider Details

I. General information

NPI: 1497092944
Provider Name (Legal Business Name): CHRISTINA CHENG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2013
Last Update Date: 04/05/2022
Certification Date: 04/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2710 PROSPERITY AVE STE 200
FAIRFAX VA
22031-4358
US

IV. Provider business mailing address

2710 PROSPERITY AVE STE 200
FAIRFAX VA
22031-4358
US

V. Phone/Fax

Practice location:
  • Phone: 703-650-2333
  • Fax: 703-650-2322
Mailing address:
  • Phone: 703-650-2333
  • Fax: 703-650-2322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License NumberML60754888
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number0101264841
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: