Provider Demographics
NPI:1912432022
Name:UNDERWOOD, JAMES AUSTIN (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:AUSTIN
Last Name:UNDERWOOD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:21475 RIDGETOP CIR STE 150
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20166-6580
Mailing Address - Country:US
Mailing Address - Phone:703-444-5000
Mailing Address - Fax:703-444-5000
Practice Address - Street 1:25055 RIDING PLZ STE 260
Practice Address - Street 2:
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20152-5922
Practice Address - Country:US
Practice Address - Phone:703-272-5000
Practice Address - Fax:703-957-3804
Is Sole Proprietor?:No
Enumeration Date:2017-04-26
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
VA01012742252081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0101274225OtherLICENSE