Physician Online Profile Updates

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NOTE: This form is meant for physicians requesting updates to their online profiles. If you are NOT an Inova credentialed physician please do not submit requests for physician information using this form.

If you looking for a doctor, search Find a Doctor, or call 1-855-MY-INOVA (1-855-694-6682).

Physicians, if you would like to be added to Inova's referral directory or update your profile information, please read and sign the participation policy and complete the physician application below.

Physician Participation Policy

  1. Physicians credentialed with Active or Provisional privileges at an Inova hospital are eligible to participate. Primary Care physicians (Family Practice, Internal Medicine and Pediatrics) with Courtesy or Community privileges at an Inova hospital are also eligible.

  2. Physicians must maintain a medical practice office in Northern Virginia.

  3. Physician practice information must be updated annually to participate.

I understand and agree with the policies governing Inova’s Physician Referral Service.
Electronic signature:
Open the calendar popup.

Request to have your profile added or submit edits

Complete the following form to be added to the physician directory or to request updates to your existing physician profile. All requests are received by Inova’s centralized credentialing office. Once received, changes will be reflected within 3 - 5 business days on all Inova systems.

First Name:
Middle Initial:
Last Name:
Contact Email Address:
NPI Number:
Practice/Group Name:
Practice website:
Referral Preferences: Please list EACH of your board certified specialties and specify whether you are accepting new patients, or you are NOT accepting new patients for each. This will help reduce consumers from being misdirected to physicians who are hospitalists or who choose not to be referable for certain services.
Language(s) other than English that you speak fluently:

Clinical Interest

Please select up to five clinical interests. If more than five are selected, only the first five will be displayed on the physician profile.

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