Individual ProviderTheresa Van Der VlugtEmergency MedicineAllopathic & Osteopathic PhysiciansPractice Address3300 Gallows Rd, Falls Church, VA 22042-3307(703) 776-3111(888) 898-3291PECOS EnrollmentBased on the most recent information from CMS, provider Theresa Van Der Vlugt is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records yesterday at 12:57 PM.Profile DetailsProvider ID1871545855Provider TypeIndividualFull NameVan Der Vlugt, TheresaCredentialMDGenderFemaleSole ProprietorNoEnumeration Date5/17/2006Last Updated7/18/2007Contact InformationPractice LocationPractice Address3300 Gallows Rd, Falls Church, VA 22042-3307Phone(703) 776-3111Fax(800) 536-8431Mailing LocationMailing AddressPO Box 75567, Baltimore, MD 21275-5567Phone(888) 898-3291Fax(800) 536-8431Provider TaxonomiesCodeDescriptionLicenseCode207P00000XPrimaryDescriptionEmergency MedicineAllopathic & Osteopathic PhysiciansLicense0101235738VirginiaProvider IdentifiersIDDescriptionIssuerID010051096DescriptionMedicaidIssuerUnlistedVirginiaIDP00150229DescriptionOtherIssuerRAILROAD MEDICAREVirginia