Provider Demographics
NPI:1417932815
Name:JOSEPHS, TAJA HELEN (MD)
Entity Type:Individual
Prefix:
First Name:TAJA
Middle Name:HELEN
Last Name:JOSEPHS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8640 SUDLEY ROAD
Mailing Address - Street 2:SUITE 303
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-4404
Mailing Address - Country:US
Mailing Address - Phone:703-361-7778
Mailing Address - Fax:703-392-6231
Practice Address - Street 1:8640 SUDLEY ROAD
Practice Address - Street 2:SUITE 303
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-4404
Practice Address - Country:US
Practice Address - Phone:703-361-7778
Practice Address - Fax:703-392-6231
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101235035207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H95872Medicare UPIN
VA002814P48Medicare ID - Type Unspecified