Individual
DR. ITORO IBIA
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
11701 BOWMAN GREEN DR, RESTON, VA 20190-3573
(703) 707-9777
(703) 707-0690
Mailing address
PO BOX 2963, RESTON, VA 20195-0963
(703) 707-9777
(703) 707-0690
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
0101223034
VA
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
0101223034
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2037353
CIGNA ID
—
01
—
466688
ANTHEM BCBS ID
VA
01
—
7267195
AETNA PROVIDER ID
—
01
—
F480-0001
CARE FIRST BCBS ID
—
Enumeration date
10/05/2005
Last updated
09/11/2025
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