Provider Demographics
NPI:1235216896
Name:SANTOS-ILAGAN, EMELINA (MD)
Entity Type:Individual
Prefix:DR
First Name:EMELINA
Middle Name:
Last Name:SANTOS-ILAGAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:EMELINA
Other - Middle Name:S
Other - Last Name:ILAGAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 10622
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22009-0622
Mailing Address - Country:US
Mailing Address - Phone:571-262-9241
Mailing Address - Fax:703-503-3112
Practice Address - Street 1:10560 MAIN ST
Practice Address - Street 2:SUITE PS 10
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-7182
Practice Address - Country:US
Practice Address - Phone:703-609-8414
Practice Address - Fax:703-503-3112
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2017-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010480812084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry