=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205437274
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MEDHEALTH360
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/05/2020
-----------------------------------------------------
Last Update Date | 11/05/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 19500 SANDRIDGE WAY STE 170
-----------------------------------------------------
City | LEESBURG
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 20176-3692
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 571-252-8400
-----------------------------------------------------
Fax | 703-554-1301
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 19500 SANDRIDGE WAY STE 170
-----------------------------------------------------
City | LEESBURG
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 20176-3692
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 571-252-8400
-----------------------------------------------------
Fax | 703-554-1301
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | HEATHER PARRESOL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 703-729-5553
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RE0101X
-----------------------------------------------------
Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------