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General NPI Number Information
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NPI Number | 1154898997
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Entity Type | Organization
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Legal Business Name | REGIONAL HEALTH PROVIDERS LLC
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Dates
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Enumeration Date | 10/30/2018
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Last Update Date | 10/31/2018
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Provider Practice Location Address
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Address Line | 3917 OLD LEE HWY STE 11D
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City | FAIRFAX
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State | VA
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Zip | 22030-2431
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Country | US
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Telephone | 703-691-4000
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Fax | 703-691-4010
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Provider Business Mailing Address
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Address Line | 3917 OLD LEE HWY STE 11D
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City | FAIRFAX
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State | VA
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Zip | 22030-2431
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Country | US
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Telephone | 703-691-4000
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Fax | 703-691-4010
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Authorized Official
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Title or Position | CREDENTIALING BILLING MANAGER
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Name | EVELYN LOCH
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Credential |
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Telephone | 703-249-9079
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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