Healthcare Provider Details

I. General information

NPI: 1356620967
Provider Name (Legal Business Name): MUNIQUE PINHEIRO MAIA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2011
Last Update Date: 12/21/2022
Certification Date: 12/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8100 BOONE BLVD STE 730
TYSONS CORNER VA
22182-2688
US

IV. Provider business mailing address

8300 GREENSBORO DR STE L1-180
MC LEAN VA
22102-3605
US

V. Phone/Fax

Practice location:
  • Phone: 703-574-4500
  • Fax: 443-949-7508
Mailing address:
  • Phone: 703-574-4500
  • Fax: 443-949-7508

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number0101264761
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: