Provider Demographics
NPI:1205853983
Name:EVERGREEN OB/GYN P.C.
Entity type:Organization
Organization Name:EVERGREEN OB/GYN P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:THUY
Authorized Official - Middle Name:N
Authorized Official - Last Name:HO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-941-5070
Mailing Address - Street 1:4330 EVERGREEN LN STE F
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-3258
Mailing Address - Country:US
Mailing Address - Phone:703-941-5070
Mailing Address - Fax:703-941-8955
Practice Address - Street 1:4328 EVERGREEN LN
Practice Address - Street 2:SUITE E
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-3257
Practice Address - Country:US
Practice Address - Phone:703-941-5070
Practice Address - Fax:703-941-8955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2007-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101032935207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA509174Medicare PIN