Healthcare Provider Details

I. General information

NPI: 1326133893
Provider Name (Legal Business Name): RICHARD LEE LAYFIELD III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 09/20/2022
Certification Date: 09/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14605 POTOMAC BRANCH DR SUITE 300
WOODBRIDGE VA
22191-4070
US

IV. Provider business mailing address

PO BOX 5237
WOODBRIDGE VA
22194-5237
US

V. Phone/Fax

Practice location:
  • Phone: 703-490-1112
  • Fax: 703-878-8735
Mailing address:
  • Phone: 703-490-1112
  • Fax: 703-878-8735

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number0101234701
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number0101234701
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: