Healthcare Provider Details

I. General information

NPI: 1861723801
Provider Name (Legal Business Name): ROBIN M MCDERMOTT NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ROBIN M FULFORD

II. Dates (important events)

Enumeration Date: 01/14/2010
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8280 WILLOW OAKS CORPORATE DR STE 600
FAIRFAX VA
22031-4516
US

IV. Provider business mailing address

15 OAK ST STE 3
NEEDHAM MA
02492-2470
US

V. Phone/Fax

Practice location:
  • Phone: 888-671-5902
  • Fax: 339-686-3137
Mailing address:
  • Phone: 888-671-5902
  • Fax: 339-686-3137

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024167768
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0024167768
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: