Healthcare Provider Details

I. General information

NPI: 1942159280
Provider Name (Legal Business Name): TELOS HEALTH SYSTEMS VA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1503 MICHAELS RD
RICHMOND VA
23229-4822
US

IV. Provider business mailing address

980 SYLVAN AVE
ENGLEWOOD CLIFFS NJ
07632-3315
US

V. Phone/Fax

Practice location:
  • Phone: 201-217-6777
  • Fax:
Mailing address:
  • Phone: 201-217-6777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: PETER BAILEY
Title or Position: CEO
Credential:
Phone: 609-480-0119