Healthcare Provider Details

I. General information

NPI: 1851385454
Provider Name (Legal Business Name): JANICE E. RAGLAND MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2005
Last Update Date: 10/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 HERNDON PKWY STE 100
HERNDON VA
20170-5276
US

IV. Provider business mailing address

555 HERNDON PKWY STE 100
HERNDON VA
20170-5276
US

V. Phone/Fax

Practice location:
  • Phone: 703-481-1505
  • Fax: 703-742-8793
Mailing address:
  • Phone: 703-481-1505
  • Fax: 703-742-8793

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101050581
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: