Healthcare Provider Details

I. General information

NPI: 1437418977
Provider Name (Legal Business Name): GAO LINDA CHEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2012
Last Update Date: 06/14/2021
Certification Date: 06/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12255 FAIR LAKES PKWY DEPT OF
FAIRFAX VA
22033-3952
US

IV. Provider business mailing address

12255 FAIR LAKES PKWY FL 4
FAIRFAX VA
22033-3952
US

V. Phone/Fax

Practice location:
  • Phone: 703-934-5770
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number101262458
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: