Healthcare Provider Details

I. General information

NPI: 1952350316
Provider Name (Legal Business Name): JUDITH CUNNINGHAM MAHONEY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JUDITH LYNNE CUNNINGHAM NP

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 11/27/2023
Certification Date: 10/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 GALLOWS RD
FALLS CHURCH VA
22042-3307
US

IV. Provider business mailing address

PO BOX 37174
BALTIMORE MD
21297-3174
US

V. Phone/Fax

Practice location:
  • Phone: 703-776-4001
  • Fax: 703-776-7113
Mailing address:
  • Phone: 571-423-5699
  • Fax: 571-423-5698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN55780
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number0024172213
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0024172213
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: