Healthcare Provider Details

I. General information

NPI: 1710959986
Provider Name (Legal Business Name): DEVASHISH SEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 08/19/2020
Certification Date: 08/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 CHATHAM SQUARE OFFICE PARK
FREDERICKSBURG VA
22405-2544
US

IV. Provider business mailing address

402 CHATHAM SQUARE OFFICE PARK
FREDERICKSBURG VA
22405-2544
US

V. Phone/Fax

Practice location:
  • Phone: 540-659-5414
  • Fax: 540-659-5415
Mailing address:
  • Phone: 540-659-5414
  • Fax: 540-659-5415

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number239890
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number0101243180
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: