Healthcare Provider Details

I. General information

NPI: 1043314438
Provider Name (Legal Business Name): RESTON HOSPITAL CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 06/23/2022
Certification Date: 06/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 TOWN CENTER PKWY
RESTON VA
20190
US

IV. Provider business mailing address

1850 TOWN CENTER PKWY
RESTON VA
20190-3219
US

V. Phone/Fax

Practice location:
  • Phone: 703-689-9000
  • Fax: 703-689-0840
Mailing address:
  • Phone: 703-689-9000
  • Fax: 703-689-0840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberH1776
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: THOMAS EISEL
Title or Position: CFO
Credential:
Phone: 703-689-9000