Provider Demographics
NPI:1003995168
Name:VASQUEZ, BETSY (MD)
Entity Type:Individual
Prefix:
First Name:BETSY
Middle Name:
Last Name:VASQUEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:46090 LAKE CENTER PLZ STE 104
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20165-5877
Mailing Address - Country:US
Mailing Address - Phone:703-421-1700
Mailing Address - Fax:703-421-5550
Practice Address - Street 1:46090 LAKE CENTER PLZ STE 104
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20165-5877
Practice Address - Country:US
Practice Address - Phone:703-421-1700
Practice Address - Fax:703-421-5550
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101052517207YP0228X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YP0228XAllopathic & Osteopathic PhysiciansOtolaryngologyPediatric Otolaryngology