Provider Demographics
NPI:1619215571
Name:DAVID B. SUMMER M.D., P.C.
Entity Type:Organization
Organization Name:DAVID B. SUMMER M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:BENJAMIN
Authorized Official - Last Name:SUMMER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-360-0111
Mailing Address - Street 1:8101 HINSON FARM RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22306-3403
Mailing Address - Country:US
Mailing Address - Phone:703-360-0111
Mailing Address - Fax:703-799-1126
Practice Address - Street 1:8101 HINSON FARM RD
Practice Address - Street 2:SUITE 103
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22306-3403
Practice Address - Country:US
Practice Address - Phone:703-360-0111
Practice Address - Fax:703-799-1126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-27
Last Update Date:2013-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101028478207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6370675Medicaid
VA045888A83Medicare PIN
VA6370675Medicaid