| Tysons Therapeutics Pllc | |
|
8320 Old Courthouse Rd Suite 400 Vienna VA 22182-3831 | |
| (703) 226-4005 | |
| (703) 226-4020 |
| Full Name | Tysons Therapeutics Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 8320 Old Courthouse Rd, Vienna, Virginia |
| Authorized Official Name and Position | Heidi Jo Crayton (MEDICAL DIRECTOR) |
| Authorized Official Contact | 7032264005 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tysons Therapeutics Pllc 8320 Old Courthouse Rd Suite 400 Vienna VA 22182-3831 Ph: (703) 226-4005 | Tysons Therapeutics Pllc 8320 Old Courthouse Rd Suite 400 Vienna VA 22182-3831 Ph: (703) 226-4005 |
| NPI Number | 1295886034 |
|---|---|
| Provider Enumeration Date | 01/16/2007 |
| Last Update Date | 03/05/2008 |
| Medicare PECOS PAC ID | 5395843577 |
|---|---|
| Medicare Enrollment ID | O20070612000406 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295886034 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 0101056335 (Virginia) | Primary |
| Provider Name | Heidi J Crayton |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1669470720 PECOS PAC ID: 9931207115 Enrollment ID: I20070612000422 |
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