Healthcare Provider Details

I. General information

NPI: 1467425876
Provider Name (Legal Business Name): RAVI R IYER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 02/20/2024
Certification Date: 02/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13505 DULLES TECHNOLOGY DRIVE, SUITE 1A
HERNDON VA
20171-3403
US

IV. Provider business mailing address

224-D CORNWALL STREET, NW, SUITE 403
LEESBURG VA
20176-2704
US

V. Phone/Fax

Practice location:
  • Phone: 703-404-5900
  • Fax: 703-421-1099
Mailing address:
  • Phone: 703-737-6010
  • Fax: 703-443-8643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101053203
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: