Provider Demographics
NPI:1043441223
Name:PHYSICIANS HEALTH SOLUTIONS
Entity Type:Organization
Organization Name:PHYSICIANS HEALTH SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF PHYSICIAN OFFICER/PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TASHA
Authorized Official - Middle Name:LATRICE
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:703-466-0455
Mailing Address - Street 1:44035 RIVERSIDE PKWY
Mailing Address - Street 2:345
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-8260
Mailing Address - Country:US
Mailing Address - Phone:703-466-0455
Mailing Address - Fax:703-726-0044
Practice Address - Street 1:44035 RIVERSIDE PKWY
Practice Address - Street 2:345
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-8260
Practice Address - Country:US
Practice Address - Phone:703-466-0455
Practice Address - Fax:703-726-0044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-05
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556539111N00000X
VA0103300977213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6551080001Medicare NSC
VAC10870Medicare UPIN