Doctor Name: | DR. ILANA ILKOVITCH BURGH |
NPI Number: | 1104142496 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PSYD |
License Number: | 0810004048 |
Business Practice Address: | 1645 International Dr 327 Mc Lean, VA - 221024816 |
Business Phone Number: | 2403547651 |
Business Fax Number: | |
Mailing Address: | 1645 International Dr, 327 MC LEAN |
State: | VA |
Postal Code: | 221024816 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 04/13/2010 |
NPI Last Update Date: | 02/04/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | 0810004048 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | VA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |