Provider Demographics
NPI:1003814534
Name:SUMMER, DAVID BENJAMIN (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:BENJAMIN
Last Name:SUMMER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:3031 JAVIER RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4637
Mailing Address - Country:US
Mailing Address - Phone:703-698-8880
Mailing Address - Fax:703-698-8884
Practice Address - Street 1:3031 JAVIER RD
Practice Address - Street 2:SUITE 300
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4637
Practice Address - Country:US
Practice Address - Phone:703-698-8880
Practice Address - Fax:703-698-8884
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2016-02-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101028478207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA006370675Medicaid
VA045888ZFY4OtherGROUP MEMBER PTAN
VA045888YT07OtherPTAN
VAC61629Medicare UPIN