Provider Demographics
NPI:1962744409
Name:AUSTIN, EVA MARIA (MD)
Entity type:Individual
Prefix:
First Name:EVA
Middle Name:MARIA
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1112 DAPPLE GREY CT
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:VA
Mailing Address - Zip Code:22066-2006
Mailing Address - Country:US
Mailing Address - Phone:703-759-4240
Mailing Address - Fax:
Practice Address - Street 1:1112 DAPPLE GREY CT
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:VA
Practice Address - Zip Code:22066-2006
Practice Address - Country:US
Practice Address - Phone:703-863-5776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-22
Last Update Date:2013-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101026948207R00000X
DCMD8153207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine