Healthcare Provider Details

I. General information

NPI: 1063466076
Provider Name (Legal Business Name): SONYA NADINE BETHEL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 05/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7440 SPRING VILLAGE DR
SPRINGFIELD VA
22150-4446
US

IV. Provider business mailing address

5525 RESEARCH PARK DR 4TH FLOOR
BALTIMORE MD
21228-4873
US

V. Phone/Fax

Practice location:
  • Phone: 703-923-4644
  • Fax: 703-923-4625
Mailing address:
  • Phone: 703-923-4644
  • Fax: 703-923-4625

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101041548
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: