Provider Demographics
NPI:1225241342
Name:DEVLIN, REGINA (CPNP, IBCLC, PMHS)
Entity Type:Individual
Prefix:
First Name:REGINA
Middle Name:
Last Name:DEVLIN
Suffix:
Gender:F
Credentials:CPNP, IBCLC, PMHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8365A GREENSBORO DR
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102-3530
Mailing Address - Country:US
Mailing Address - Phone:703-356-4444
Mailing Address - Fax:
Practice Address - Street 1:8365A GREENSBORO DR
Practice Address - Street 2:
Practice Address - City:MCLEAN
Practice Address - State:VA
Practice Address - Zip Code:22102-3530
Practice Address - Country:US
Practice Address - Phone:703-356-4444
Practice Address - Fax:703-734-0129
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024109557208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0001109557OtherMULTI-STATE PRIVILEGE
VA0017136894OtherAUTH. TO PRESCRIBE VAONLY
VA0024109557OtherVA STATE LICENSE