Provider Demographics
NPI:1376635003
Name:ROBERT S ENELOW MD AND STUART HENOCHOWICZ MD PC
Entity Type:Organization
Organization Name:ROBERT S ENELOW MD AND STUART HENOCHOWICZ MD PC
Other - Org Name:INTERNAL MEDICINE & ALLERGY ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:KREITMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-425-7550
Mailing Address - Street 1:6035 BURKE CENTRE PKWY
Mailing Address - Street 2:SUITE 120
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22015-3750
Mailing Address - Country:US
Mailing Address - Phone:703-425-6010
Mailing Address - Fax:703-425-7504
Practice Address - Street 1:6035 BURKE CENTRE PKWY
Practice Address - Street 2:SUITE 120
Practice Address - City:BURKE
Practice Address - State:VA
Practice Address - Zip Code:22015-3750
Practice Address - Country:US
Practice Address - Phone:703-425-6010
Practice Address - Fax:703-425-7504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101042350207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
595284OtherPTAN
595284OtherPTAN