Healthcare Provider Details

I. General information

NPI: 1760625479
Provider Name (Legal Business Name): JOSEPH R. BALZARETT, M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2009
Last Update Date: 04/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8206 LEESBURG PIKE STE 207
VIENNA VA
22182-2614
US

IV. Provider business mailing address

8206 LEESBURG PIKE STE 207
VIENNA VA
22182-2614
US

V. Phone/Fax

Practice location:
  • Phone: 703-893-8585
  • Fax: 703-893-3879
Mailing address:
  • Phone: 703-893-8585
  • Fax: 703-893-3879

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number0101023170
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number0101023170
License Number StateVA

VIII. Authorized Official

Name: DR. JOSEPH R. BALZARETT
Title or Position: PSYCHIATRIST
Credential: M.D.
Phone: 703-893-8585