Healthcare Provider Details

I. General information

NPI: 1104025758
Provider Name (Legal Business Name): MEGAN BARTSCH WILLEMS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2007
Last Update Date: 10/13/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6862 ELM ST SUITE 230
MC LEAN VA
22101-3897
US

IV. Provider business mailing address

6862 ELM ST SUITE 230
MC LEAN VA
22101-3897
US

V. Phone/Fax

Practice location:
  • Phone: 703-942-6101
  • Fax: 703-663-9860
Mailing address:
  • Phone: 703-942-6101
  • Fax: 703-663-9860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number232117
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number0101246907
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0101246907
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number232117
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: