Healthcare Provider Details

I. General information

NPI: 1083541684
Provider Name (Legal Business Name): MEGUMI TERAKAWA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9202 MATTHEW DR
MANASSAS PARK VA
20111-2445
US

IV. Provider business mailing address

9202 MATTHEW DR
MANASSAS PARK VA
20111-2445
US

V. Phone/Fax

Practice location:
  • Phone: 571-314-0586
  • Fax:
Mailing address:
  • Phone: 571-314-0586
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberU03206
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number0121001253
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: