Provider Demographics
NPI:1962064949
Name:RADICH, PATRICIA A (DO)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:A
Last Name:RADICH
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:PO BOX 417
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22038-0417
Mailing Address - Country:US
Mailing Address - Phone:703-901-3725
Mailing Address - Fax:
Practice Address - Street 1:2070 CHAIN BRIDGE RD STE 150
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-2598
Practice Address - Country:US
Practice Address - Phone:703-383-4836
Practice Address - Fax:703-383-4911
Is Sole Proprietor?:No
Enumeration Date:2019-07-01
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102207297207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine