Healthcare Provider Details

I. General information

NPI: 1194781575
Provider Name (Legal Business Name): ANCA VALERIA ILIESCU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 CAMPUS BLVD SUITE 200
WINCHESTER VA
22601
US

IV. Provider business mailing address

190 CAMPUS BLVD SUITE 200
WINCHESTER VA
22601
US

V. Phone/Fax

Practice location:
  • Phone: 540-662-0306
  • Fax: 540-662-5845
Mailing address:
  • Phone: 540-662-0306
  • Fax: 540-662-5845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number0101238812
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: