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EXECUTIVE HEALTHCARE SERVICES PLLC
NPI 1760664007
Family Medicine in Reston, VA

Active since November 28, 2007CLIA 49D2159857 · Waiver
12040 S LAKES DR, SUITE 195, RESTON, VA 20191(703) 230-0347(703) 230-0350 Get Directions Write a Review

NPPES record last updated: August 25, 2022. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Aug 25, 2022, Aug 22, 2018 (2 updates tracked since 2018).

About Executive Healthcare Services Pllc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

EXECUTIVE HEALTHCARE SERVICES PLLC (NPI 1760664007) is a healthcare organization registered as a family medicine in Reston, Virginia and active in the NPI registry since November 2007. The organization holds a CLIA Waiver certificate valid through December 27, 2026, maintains a secondary practice location in Potomac, and lists Cheryl Eccleston, Administrator, as its authorized official.

NPPES Registry Identity

NPI1760664007
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NameEXECUTIVE HEALTHCARE SERVICES PLLC
Location Address12040 S LAKES DR, SUITE 195Reston, VA 20191
Mailing Address12040 S Lakes Dr Ste 204Reston, VA 20191-1236 · (703) 230-0347 · Fax (703) 230-0350
Phone(703) 230-0347
Fax(703) 230-0350
Organization SubpartNo
Authorized OfficialCheryl EcclestonAdministrator · (703) 230-0347
Enumeration DateNovember 28, 2007
Last NPPES UpdateAugust 25, 20222 updates tracked since enumeration
NPPES CertifiedAugust 25, 2022
✔ NPI 1760664007 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
License✔ Licensed in VA · 0101050406
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
12040 S LAKES DR, Reston, VA 20191
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Secondary Practice Location 1

Location 17811 Montrose Rd # 530Potomac, MD 20854-3363 · Phone (240) 599-5400

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 49D2159857

Executive Healthcare Services · Reston, VA
Active · expires Dec 27, 2026
CLIA Number49D2159857
Laboratory TypePhysician Office
Certificate Effective DateDecember 28, 2024
Certificate Expiration DateDecember 27, 2026
Laboratory DirectorKevin J. Kelleher
Laboratory Phone(703) 230-0347
Laboratory LocationExecutive Healthcare Services12040 South Lakes Dr #204, Reston, VA 20191
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 12

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

GENERATIONS FAMILY MEDICINE PC
Family Medicine
12040 S LAKES DR, STE 190
RESTON, VA 20191
Fairfax County (703) 464-0686
DR. JOHN P MAMANA M.D.
Internal Medicine
12040 S LAKES DR, SUITE 205
RESTON, VA 20191
Fairfax County (703) 230-6990
EHS CORPORATE CARE
Internal Medicine
12040 S LAKES DR, SUITE 205
RESTON, VA 20191
Fairfax County (703) 230-6990
MR. MARK EMANUEL VASILIADIS M.D.
Family Medicine
12040 S LAKES DR, SUITE 195
RESTON, VA 20191
Fairfax County (703) 230-0347
DR. KEVIN J KELLEHER MD
Family Medicine
12040 S LAKES DR, STE 207
RESTON, VA 20191
Fairfax County (703) 464-0686
LAURA LISBETH KENNEDY RN, FNP-BC
Nurse Practitioner (Family)
12040 S LAKES DR
RESTON, VA 20191
Fairfax County (703) 464-0686
DEANNA LYNN MARKLEY PA
Physician Assistant (Medical)
12040 S LAKES DR, SUITE 207
RESTON, VA 20191
Fairfax County (703) 464-0686
ARAMESH DARVISHIAN DDS
Dentist
12040 S LAKES DR, SUITE 200
RESTON, VA 20191
Fairfax County (703) 955-4440

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Executive Healthcare Services PLLC's NPI number?

The NPI number for Executive Healthcare Services PLLC is 1760664007. It was assigned to this organization in the NPPES registry on November 28, 2007.

Where is Executive Healthcare Services PLLC located?

Executive Healthcare Services PLLC is located at 12040 S Lakes Dr Suite 195, Reston, VA 20191. The listed phone number is (703) 230-0347.

What is Executive Healthcare Services PLLC's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Does Executive Healthcare Services PLLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 49D2159857) is associated with this NPI, valid through December 27, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Executive Healthcare Services PLLC was last updated on August 25, 2022. NPI Profile syncs with the weekly NPPES data releases published by CMS.