Healthcare Provider Details

I. General information

NPI: 1982160891
Provider Name (Legal Business Name): BLAINE SARAH TOTH CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BLAINE SARAH GRAY CRNP

II. Dates (important events)

Enumeration Date: 02/15/2019
Last Update Date: 11/07/2024
Certification Date: 11/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 GALLOWS RD
FALLS CHURCH VA
22042-3307
US

IV. Provider business mailing address

43750 LEES MILL SQ
LEESBURG VA
20176-3821
US

V. Phone/Fax

Practice location:
  • Phone: 703-698-4444
  • Fax:
Mailing address:
  • Phone: 301-366-3299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAC002615
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0024180252
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: