Individual
RICHARD ILOG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
7026 COMMERCE ST, SPRINGFIELD, VA 22150-3433
(301) 728-4956
Mailing address
7026 COMMERCE ST, SPRINGFIELD, VA 22150-3433
(301) 728-4956
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
8983
VA
Other
Enumeration date
04/04/2024
Last updated
04/04/2024
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