Healthcare Provider Details

I. General information

NPI: 1770688277
Provider Name (Legal Business Name): CHRISTOPHER ROBERT VAN EYCK PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 09/21/2020
Certification Date: 09/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

239 GARRISONVILLE RD STE 201
STAFFORD VA
22554-1554
US

IV. Provider business mailing address

3123 NORTHWOOD RD
FAIRFAX VA
22031-1014
US

V. Phone/Fax

Practice location:
  • Phone: 703-373-7338
  • Fax:
Mailing address:
  • Phone: 703-828-4383
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number1749
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0110004052
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: