Healthcare Provider Details

I. General information

NPI: 1851332605
Provider Name (Legal Business Name): INIA I YEVICH-TUNSTALL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 06/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8136 OLD KEENE MILL RD SUITE A205
SPRINGFIELD VA
22152-1851
US

IV. Provider business mailing address

8136 OLD KEENE MILL RD SUITE A205
SPRINGFIELD VA
22152-1851
US

V. Phone/Fax

Practice location:
  • Phone: 703-866-2881
  • Fax: 703-866-2884
Mailing address:
  • Phone: 703-866-2881
  • Fax: 703-866-2884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number0101043927
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: