Provider Demographics
NPI:1447202510
Name:VIRGINIA CENTER FOR ALLERGY, ASTHMA AND SINUS, PC
Entity Type:Organization
Organization Name:VIRGINIA CENTER FOR ALLERGY, ASTHMA AND SINUS, PC
Other - Org Name:ACCREDITED ALLERGY CENTER OF SPRINGFIELD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:TEAGUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-569-1913
Mailing Address - Street 1:8134 OLD KEENE MILL RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22152-1849
Mailing Address - Country:US
Mailing Address - Phone:703-569-1913
Mailing Address - Fax:
Practice Address - Street 1:8134 OLD KEENE MILL RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22152-1800
Practice Address - Country:US
Practice Address - Phone:703-569-1913
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101237445207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAI47384Medicare UPIN
VA10191734Medicare ID - Type UnspecifiedLMG
DCG01832Medicare ID - Type Unspecified