Healthcare Provider Details

I. General information

NPI: 1003009119
Provider Name (Legal Business Name): TROY RANDOLPH MOHLER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2007
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

224-D CORNWALL STREET, NW, SUITE 106
LEESBURG VA
20176-2700
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 703-777-1612
  • Fax: 703-777-2638
Mailing address:
  • Phone: 703-737-6010
  • Fax: 703-443-8643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101245677
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: