Provider Demographics
NPI:1003450636
Name:CONVERTI, TAEJEAN (DOM, MSOM, LAC)
Entity Type:Individual
Prefix:MS
First Name:TAEJEAN
Middle Name:
Last Name:CONVERTI
Suffix:
Gender:F
Credentials:DOM, MSOM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8909 DAY LILLY CT
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-1464
Mailing Address - Country:US
Mailing Address - Phone:703-864-3636
Mailing Address - Fax:
Practice Address - Street 1:8909 DAY LILLY CT
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-1464
Practice Address - Country:US
Practice Address - Phone:703-864-3636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-06
Last Update Date:2020-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist