Provider Demographics
NPI:1275747826
Name:INIA YEVICH-TUNSTALL, MD
Entity Type:Organization
Organization Name:INIA YEVICH-TUNSTALL, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:INIA
Authorized Official - Middle Name:I
Authorized Official - Last Name:YEVICH-TUNSTALL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-866-2881
Mailing Address - Street 1:8136 OLD KEENE MILL RD
Mailing Address - Street 2:A205
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22152-1850
Mailing Address - Country:US
Mailing Address - Phone:703-866-2881
Mailing Address - Fax:703-866-2884
Practice Address - Street 1:8136 OLD KEENE MILL RD
Practice Address - Street 2:A205
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22152-1850
Practice Address - Country:US
Practice Address - Phone:703-866-2881
Practice Address - Fax:703-866-2884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101043927174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC622269Medicare ID - Type Unspecified
VAE52294Medicare UPIN