Individual
DR. MINGLIARTI TJAHJANA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1850 TOWN CENTER PKWY, SUITE 410, RESTON, VA 20190-3219
(571) 572-9198
(571) 482-6080
Mailing address
12504 ALEXANDER CORNELL DR, FAIRFAX, VA 22033-2437
(571) 338-9054
(571) 482-6080
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
0101236144
VA
Other
Enumeration date
08/08/2006
Last updated
12/09/2016
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