Provider Demographics
NPI:1013171552
Name:THEODOSIADIS, EVA MARIA (MD)
Entity type:Individual
Prefix:DR
First Name:EVA
Middle Name:MARIA
Last Name:THEODOSIADIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:6845 ELM ST
Mailing Address - Street 2:SUITE 507
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-6007
Mailing Address - Country:US
Mailing Address - Phone:571-282-8254
Mailing Address - Fax:571-267-3083
Practice Address - Street 1:6845 ELM ST
Practice Address - Street 2:SUITE 507
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-6007
Practice Address - Country:US
Practice Address - Phone:571-282-8254
Practice Address - Fax:571-267-3083
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-14
Last Update Date:2017-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2598462084P0800X, 2084P0804X
DCMD0406942084F0202X, 2084P0800X, 2084P0804X
VA01012517472084P0804X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry