Healthcare Provider Details

I. General information

NPI: 1013483270
Provider Name (Legal Business Name): EMELIA F ANDOH DR.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2018
Last Update Date: 10/15/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

334 ELDEN ST
HERNDON VA
20170-4818
US

IV. Provider business mailing address

6 RALEIGH LN
STAFFORD VA
22554-8835
US

V. Phone/Fax

Practice location:
  • Phone: 571-665-4000
  • Fax:
Mailing address:
  • Phone: 703-861-2039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024176259
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: