Healthcare Provider Details

I. General information

NPI: 1376599001
Provider Name (Legal Business Name): MISHRA & MISHRA, MD, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 12/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6845 ELM ST STE 700
MC LEAN VA
22101-3851
US

IV. Provider business mailing address

6845 ELM ST STE 700
MC LEAN VA
22101-3851
US

V. Phone/Fax

Practice location:
  • Phone: 703-356-1105
  • Fax: 703-356-0970
Mailing address:
  • Phone: 703-356-1105
  • Fax: 703-356-0970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LEAH GAEDEKE
Title or Position: FNP/CLINIC ADMINISTRATOR
Credential:
Phone: 703-356-1105