Provider Demographics
NPI:1194854877
Name:SIMMONS, STEVEN PARKER (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:PARKER
Last Name:SIMMONS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 MAPLE AVE W STE E
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22180-5614
Mailing Address - Country:US
Mailing Address - Phone:703-938-4604
Mailing Address - Fax:703-938-4618
Practice Address - Street 1:360 MAPLE AVE W STE E
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22180-5614
Practice Address - Country:US
Practice Address - Phone:703-938-4604
Practice Address - Fax:703-938-4618
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2009-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101058238207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
014064K92Medicare ID - Type Unspecified
G30607Medicare UPIN