Healthcare Provider Details

I. General information

NPI: 1265439343
Provider Name (Legal Business Name): PHUONG XUAN MAI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2005
Last Update Date: 11/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6620 KEENE DR
SPRINGFIELD VA
22152-2508
US

IV. Provider business mailing address

6620 KEENE DR
SPRINGFIELD VA
22152-2508
US

V. Phone/Fax

Practice location:
  • Phone: 703-598-5910
  • Fax: 703-639-0738
Mailing address:
  • Phone: 703-598-5910
  • Fax: 703-639-0738

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number0101233304
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: