Healthcare Provider Details

I. General information

NPI: 1750157079
Provider Name (Legal Business Name): RACHAEL COHEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2023
Last Update Date: 11/28/2023
Certification Date: 11/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 BEVERLY RD STE 210
MC LEAN VA
22101-3736
US

IV. Provider business mailing address

4040 FAIRFAX DR
ARLINGTON VA
22203-1613
US

V. Phone/Fax

Practice location:
  • Phone: 703-288-8260
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: