Healthcare Provider Details

I. General information

NPI: 1568725786
Provider Name (Legal Business Name): TYSONS-MCLEAN ASC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2012
Last Update Date: 06/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7601 LEWINSVILLE RD SUITE 440
MC LEAN VA
22102-2814
US

IV. Provider business mailing address

7601 LEWINSVILLE RD SUITE 440
MC LEAN VA
22102-2814
US

V. Phone/Fax

Practice location:
  • Phone: 703-676-3133
  • Fax:
Mailing address:
  • Phone: 703-676-3133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: DR. HAVEN BARLOW
Title or Position: SECRETARY TREASURER
Credential: M.D
Phone: 703-287-8277