Healthcare Provider Details

I. General information

NPI: 1912193970
Provider Name (Legal Business Name): LAUREN GEVANA OUTLAW MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2007
Last Update Date: 12/18/2024
Certification Date: 12/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6400 ARLINGTON BLVD STE 510
FALLS CHURCH VA
22042-2325
US

IV. Provider business mailing address

6400 ARLINGTON BLVD STE 510
FALLS CHURCH VA
22042-2325
US

V. Phone/Fax

Practice location:
  • Phone: 571-425-4100
  • Fax: 571-425-4300
Mailing address:
  • Phone: 571-425-4100
  • Fax: 571-254-4300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberD90375
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207VB0002X
TaxonomyObesity Medicine (Obstetrics & Gynecology) Physician
License NumberMD048786
License Number StateDC
# 3
Primary TaxonomyY
Taxonomy Code207VB0002X
TaxonomyObesity Medicine (Obstetrics & Gynecology) Physician
License Number0101257441
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: