MEDICARE: DR. PHUONG XUAN MAI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208100000X	Physical Medicine & Rehabilitation Physician	0101233304	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265439343
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PHUONG XUAN MAI MD

Provider Business Mailing Address
First Line	:	6620 KEENE DR
Second Line	:
City	:	SPRINGFIELD
State	:	VA
Zip	:	22152-2508
Country	:	US
Telephone Number	:	703-598-5910
Fax Number	:	703-639-0738

Provider Business Practice Location Address
First Line	:	6620 KEENE DR
Second Line	:
City	:	SPRINGFIELD
State	:	VA
Zip	:	22152-2508
Country	:	US
Telephone Number	:	703-598-5910
Fax Number	:	703-639-0738

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/05/2005
Last Update Date	:	11/05/2009

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