Provider Demographics
NPI:1568850931
Name:LOKHMOTOV, ROMAN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ROMAN
Middle Name:
Last Name:LOKHMOTOV
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 JEFFERSON DAVIS HWY STE 511
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22202-3609
Mailing Address - Country:US
Mailing Address - Phone:202-759-4315
Mailing Address - Fax:
Practice Address - Street 1:2001 JEFFERSON DAVIS HWY STE 511
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22202-3609
Practice Address - Country:US
Practice Address - Phone:202-759-4315
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-07
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810005027103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical