Provider Demographics
NPI:1487763074
Name:FARIA, DUYEN T (DO)
Entity type:Individual
Prefix:
First Name:DUYEN
Middle Name:T
Last Name:FARIA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2236C GALLOWS RD
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-5200
Mailing Address - Country:US
Mailing Address - Phone:703-827-7008
Mailing Address - Fax:703-827-7011
Practice Address - Street 1:2236C GALLOWS RD
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-5200
Practice Address - Country:US
Practice Address - Phone:703-827-7008
Practice Address - Fax:703-827-7011
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102050058207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
00B471E58Medicare ID - Type Unspecified
E78176Medicare UPIN