Healthcare Provider Details

I. General information

NPI: 1225042195
Provider Name (Legal Business Name): ANITA M MAYBACH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 10/10/2025
Certification Date: 10/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

381 STUYVESANT ST STE 1
WARRENTON VA
20186-2400
US

IV. Provider business mailing address

PO BOX 223323
CHANTILLY VA
20153-3323
US

V. Phone/Fax

Practice location:
  • Phone: 540-347-4410
  • Fax:
Mailing address:
  • Phone: 540-349-0595
  • Fax: 540-349-0587

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License Number0101230734
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number0101230734
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: