Individual
ANDREW JOHN ITUTUD DERKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHYSICIAN ASSISTANT
Contact information
Practice address
8260 WILLOW OAKS CORPORATE DR STE 650, FAIRFAX, VA 22031-4531
(703) 776-2000
Mailing address
8260 WILLOW OAKS CORPORATE DR STE 650, FAIRFAX, VA 22031-4531
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0110009513
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1295218089
—
VA
05
—
30017944150001
—
VA
Enumeration date
09/08/2018
Last updated
11/10/2025
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