Individual
STACEY PATRICIA VIAL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
10530 ROSEHAVEN ST STE 100, FAIRFAX, VA 22030-2888
(703) 938-0363
(703) 938-8653
Mailing address
10530 ROSEHAVEN ST STE 100, FAIRFAX, VA 22030-2888
(703) 938-0363
(703) 938-8653
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
0101259303
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03935081
—
MS
05
—
1056499
—
LA
Enumeration date
05/17/2007
Last updated
12/21/2021
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