=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922301423
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SAMANTHA MADHOSINGH PSYD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/06/2010
-----------------------------------------------------
Last Update Date | 12/06/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1934 OLD GALLOWS RD 350
-----------------------------------------------------
City | VIENNA
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22182-4042
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-717-5060
-----------------------------------------------------
Fax | 703-652-8326
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1934 OLD GALLOWS RD 350
-----------------------------------------------------
City | VIENNA
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 22182-4042
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-717-5060
-----------------------------------------------------
Fax | 703-652-8326
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 0810003364
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | PSY1000235
-----------------------------------------------------
License Number State | DC
-----------------------------------------------------