MEDICARE: SIPHATH CHREA 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	208D00000X	General Practice Physician	0101036442	VA

General Provider Information

NPI Number	:	1851400469
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SIPHATH CHREA MD

Provider Business Mailing Address
First Line	:	3215 COLUMBIA PIKE STE 103
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22204-4359
Country	:	US
Telephone Number	:	703-486-0716
Fax Number	:	703-486-0716

Provider Business Practice Location Address
First Line	:	3215 COLUMBIA PIKE STE 103
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22204-4359
Country	:	US
Telephone Number	:	703-486-0716
Fax Number	:	703-486-0716

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

Provider Enumeration Date	:	08/29/2006
Last Update Date	:	07/08/2007

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