Healthcare Provider Details

I. General information

NPI: 1740489244
Provider Name (Legal Business Name): TYSONS PSYCHIATRIC GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2007
Last Update Date: 07/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7659 LEESBURG PIKE
FALLS CHURCH VA
22043-2520
US

IV. Provider business mailing address

7659 LEESBURG PIKE
FALLS CHURCH VA
22043-2520
US

V. Phone/Fax

Practice location:
  • Phone: 703-356-5888
  • Fax:
Mailing address:
  • Phone: 703-356-5888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: ALLAN S MELMED
Title or Position: OWNER
Credential: MD
Phone: 703-356-5888