Individual
PHILIP TYLER MINSHEW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2722 MERRILEE DR, STE 230, FAIRFAX, VA 22031-4420
(703) 698-4483
(703) 573-0880
Mailing address
2722 MERRILEE DR, SUITE 230, FAIRFAX, VA 22031-4420
(703) 698-4483
(703) 573-0880
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
0101243052
VA
2085R0202X
Diagnostic Radiology Physician
A91817
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0101243052
MEDICAL LICENSE
VA
01
—
0104
CAREFIRST BCBS
VA
01
—
273522
KAISER PERMANENTE
VA
05
—
3810011982
—
WV
01
—
P00622666
RR MEDICARE
DC
Enumeration date
01/27/2006
Last updated
10/29/2008
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