Provider Demographics
NPI:1932352838
Name:DAVID E. HIATT PHD MD PC
Entity Type:Organization
Organization Name:DAVID E. HIATT PHD MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ELLIS
Authorized Official - Last Name:HIATT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-821-7966
Mailing Address - Street 1:6845 ELM ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-6007
Mailing Address - Country:US
Mailing Address - Phone:703-821-7966
Mailing Address - Fax:703-734-1441
Practice Address - Street 1:6845 ELM ST
Practice Address - Street 2:SUITE 400
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-6007
Practice Address - Country:US
Practice Address - Phone:703-821-7966
Practice Address - Fax:703-734-1441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-23
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101045403261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health