Provider Demographics
NPI:1861973315
Name:ABEDEJOS, IAN TRISTAN SERING
Entity type:Individual
Prefix:
First Name:IAN TRISTAN
Middle Name:SERING
Last Name:ABEDEJOS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 E FAIRFAX ST APT 219
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22046-2906
Mailing Address - Country:US
Mailing Address - Phone:571-635-0770
Mailing Address - Fax:
Practice Address - Street 1:2601 BEL PRE RD
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20906-2313
Practice Address - Country:US
Practice Address - Phone:301-598-6000
Practice Address - Fax:301-598-4678
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-23
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD26822225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist