Healthcare Provider Details

I. General information

NPI: 1962315382
Provider Name (Legal Business Name): EVERLINE PROFESSIONALS, P.A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2026
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8320 OLD COURTHOUSE RD STE 401
VIENNA VA
22182-3848
US

IV. Provider business mailing address

102 S UNION ST
ALEXANDRIA VA
22314-3324
US

V. Phone/Fax

Practice location:
  • Phone: 347-218-0393
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DOUGLAS ELWOOD
Title or Position: PRESIDENT
Credential: MD
Phone: 347-218-0393