Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Commonwealth of Virginia Dept of Mental Health and Northern Virginia T

Organization Geriatric Medicine (Internal Medicine) Physician · NPI 1811171309

Commonwealth of Virginia Dept of Mental Health and Northern Virginia T is a Geriatric Medicine (Internal Medicine) Physician in Fairfax, Virginia. Licensed in Virginia. Registered with an NPI since 2007.

Licensed in
VA
In the registry since
2007
Specialties on file
4

Practice location Address checks out

9901 Braddock Rd
Fairfax, VA 22032-1904
Phone: (703) 323-4093
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Geriatric Medicine (Internal Medicine) Physician (primary) Taxonomy 207RG0300X · Licence 0101233274 (VA)
Pediatrics Physician Taxonomy 208000000X · Licence 0101040712 (VA)
Neurology Physician Taxonomy 2084N0400X · Licence 0101046923 (VA)
Neurodevelopmental Disabilities Physician Taxonomy 2084P0005X · Licence 0101034545 (VA)

Record details

NPI number1811171309
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Shaquwanda Baker — Office Manager · (703) 323-4093
NPI enumeratedDecember 20, 2007
Last updated in NPPESJune 19, 2008
Mailing address9901 Braddock Rd, Fairfax, VA 22032-1904

Other providers in Fairfax