Individual
ANCA I SISU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
20 S QUAKER LN STE 220, ALEXANDRIA, VA 22314-4500
(703) 215-2454
(703) 828-0246
Mailing address
20 S QUAKER LN STE 220, ALEXANDRIA, VA 22314-4500
(703) 215-2454
(703) 828-0246
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0101262726
VA
Other
Enumeration date
06/15/2010
Last updated
06/12/2019
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