Basic Information
| Provider Information | |||||||||
| NPI: | 1225241342 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DEVLIN | ||||||||
| FirstName: | REGINA | ||||||||
| MiddleName: | |||||||||
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| Credential: | CPNP, IBCLC, PMHS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8365A GREENSBORO DR | ||||||||
| Address2: | |||||||||
| City: | MC LEAN | ||||||||
| State: | VA | ||||||||
| PostalCode: | 221023530 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7033564444 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 8365A GREENSBORO DR | ||||||||
| Address2: | |||||||||
| City: | MCLEAN | ||||||||
| State: | VA | ||||||||
| PostalCode: | 221023530 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7033564444 | ||||||||
| FaxNumber: | 7037340129 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/07/2007 | ||||||||
| LastUpdateDate: | 05/13/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 0024109557 | VA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 0001109557 | 01 | VA | MULTI-STATE PRIVILEGE | OTHER | 0017136894 | 01 | VA | AUTH. TO PRESCRIBE VAONLY | OTHER | 0024109557 | 01 | VA | VA STATE LICENSE | OTHER |