Provider Demographics
NPI:1205055621
Name:MYRIAM URRUTIA-EDER, M.D., P.C.
Entity type:Organization
Organization Name:MYRIAM URRUTIA-EDER, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MYRIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:URRUTIA-EDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-360-0594
Mailing Address - Street 1:2616 SHERWOOD HALL LN
Mailing Address - Street 2:SUITE 203
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22306-3154
Mailing Address - Country:US
Mailing Address - Phone:703-360-0594
Mailing Address - Fax:703-780-9518
Practice Address - Street 1:2616 SHERWOOD HALL LN
Practice Address - Street 2:SUITE 203
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22306-3100
Practice Address - Country:US
Practice Address - Phone:703-360-0594
Practice Address - Fax:703-780-9518
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101035616174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006001700Medicaid
VAC88599Medicare UPIN
VAG02495Medicare PIN