Healthcare Provider Details

I. General information

NPI: 1437325552
Provider Name (Legal Business Name): ANNIE XIAOYIN XU MCLENAHAN DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANNIE XIAOYIN XU DPM

II. Dates (important events)

Enumeration Date: 05/08/2008
Last Update Date: 11/19/2021
Certification Date: 11/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6501 LOISDALE CT KAISER PERMANENTE SPRINGFIELD MEDICAL CENTER
SPRINGFIELD VA
22150-1826
US

IV. Provider business mailing address

2101 E JEFFERSON ST KAISER PERMANENTE MEDICARE ENROLLMENT
ROCKVILLE MD
20852-4908
US

V. Phone/Fax

Practice location:
  • Phone: 703-922-1000
  • Fax:
Mailing address:
  • Phone: 301-816-2424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number0116018823
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: