Provider Demographics
NPI:1962422022
Name:ZHU, QINGYAN (MD)
Entity type:Individual
Prefix:DR
First Name:QINGYAN
Middle Name:
Last Name:ZHU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CHERRY
Other - Middle Name:
Other - Last Name:ZHU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:15154 CARROLLTON BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:CARROLLTON
Mailing Address - State:VA
Mailing Address - Zip Code:23314-2316
Mailing Address - Country:US
Mailing Address - Phone:757-745-7555
Mailing Address - Fax:757-745-7560
Practice Address - Street 1:15154 CARROLLTON BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:CARROLLTON
Practice Address - State:VA
Practice Address - Zip Code:23314-2316
Practice Address - Country:US
Practice Address - Phone:757-745-7555
Practice Address - Fax:757-745-7560
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2013-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012292522084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7117680Medicaid
VA00V708N93Medicare ID - Type Unspecified
VAH63637Medicare UPIN