Provider Demographics
NPI:1093992570
Name:ENT & ALLERGY SPECIALISTS OF VIRGINIA PC
Entity Type:Organization
Organization Name:ENT & ALLERGY SPECIALISTS OF VIRGINIA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-723-8727
Mailing Address - Street 1:44320 PREMIER PLZ
Mailing Address - Street 2:SUITE 110
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-5076
Mailing Address - Country:US
Mailing Address - Phone:703-723-8727
Mailing Address - Fax:703-723-9787
Practice Address - Street 1:44320 PREMIER PLZ
Practice Address - Street 2:SUITE 110
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-5076
Practice Address - Country:US
Practice Address - Phone:703-723-8727
Practice Address - Fax:703-723-9787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-27
Last Update Date:2009-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101242747207KA0200X
VA0101237837207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic SurgeryGroup - Multi-Specialty
No207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0101237837Medicaid
C10495Medicare PIN