Executive Healthcare Services PLLC
Family Medicine in Reston, VA. Organization (NPI-2).
NPI number1760664007
StatusActive
Last updated in NPPESAug 25, 2022
Details
- NPI
- 1760664007
- Entity type
- Organization (NPI-2)
- Legal business name
- Executive Healthcare Services PLLC
- Organization subpart
- No
- Enumeration date
- Nov 28, 2007
- Certification date
- Aug 25, 2022
- Last updated
- Aug 25, 2022
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207Q00000X | Family Medicine | 0101050406 | VA | Yes |
Practice location
12040 S Lakes DrSuite 195
Reston, VA 20191
Phone 703-230-0347 · Fax 703-230-0350
Mailing address
12040 S Lakes Dr Ste 204Reston, VA 20191-1236
Phone 703-230-0347 · Fax 703-230-0350
Other practice locations
7811 Montrose Rd # 530
Potomac, MD 20854-3363
Potomac, MD 20854-3363
Phone 240-599-5400
Authorized official
Cheryl Eccleston
Administrator
7032300347
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