Healthcare Provider Details

I. General information

NPI: 1780799643
Provider Name (Legal Business Name): CATHY MCLERNON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 05/28/2021
Certification Date: 05/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1890 METRO CENTER DR
RESTON VA
20190-5286
US

IV. Provider business mailing address

11478 ORCHARD LN
RESTON VA
20190-4435
US

V. Phone/Fax

Practice location:
  • Phone: 703-709-1500
  • Fax:
Mailing address:
  • Phone: 571-235-4849
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101234657
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: