Individual
MICHAEL JOSEPH EBLAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
8081 INNOVATION PARK DR, FAIRFAX, VA 22031-4867
(571) 472-0606
(571) 472-0540
Mailing address
9568 KINGS CHARTER DR STE 202, ASHLAND, VA 23005-7955
(804) 266-8717
(804) 266-5677
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
0101260437
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1962795773
—
VA
Enumeration date
05/26/2011
Last updated
07/10/2019
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