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General NPI Number Information
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NPI Number | 1457409633
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Entity Type | Organization
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Legal Business Name | PAGE MOSS FLETCHER MD PC
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Dates
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Enumeration Date | 01/06/2007
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Last Update Date | 02/27/2008
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Provider Practice Location Address
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Address Line | 224 CORNWALL ST NW
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City | LEESBURG
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State | VA
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Zip | 20176-2701
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Country | US
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Telephone | 703-779-4020
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 6264
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City | LEESBURG
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State | VA
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Zip | 20178-7440
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Country | US
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Telephone | 703-779-4020
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | PAGE M FLETCHER
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Credential | MD
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Telephone | 703-779-4020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0805X
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Taxonomy Name | Geriatric Psychiatry Physician
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License Number | 0101050872
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License Number State | VA
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