Healthcare Provider Details

I. General information

NPI: 1659538478
Provider Name (Legal Business Name): VIRGINIA P MADEY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: VIRGINIA S PARK M.D.

II. Dates (important events)

Enumeration Date: 05/20/2008
Last Update Date: 01/15/2024
Certification Date: 01/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6501 LOISDALE CT
SPRINGFIELD VA
22150-1826
US

IV. Provider business mailing address

6501 LOISDALE CT
SPRINGFIELD VA
22150-1826
US

V. Phone/Fax

Practice location:
  • Phone: 703-359-7878
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number0101252180
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: