Healthcare Provider Details

I. General information

NPI: 1154020428
Provider Name (Legal Business Name): REACH SPECIALTIES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2023
Last Update Date: 02/28/2023
Certification Date: 02/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8230 BOONE BLVD STE 170
VIENNA VA
22182-2621
US

IV. Provider business mailing address

2315 N FLORIDA ST
ARLINGTON VA
22207-1729
US

V. Phone/Fax

Practice location:
  • Phone: 571-310-2502
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: HUBERT PHAM
Title or Position: CEO
Credential:
Phone: 571-748-5432