Provider Demographics
NPI:1649563099
Name:SYNCHRONY HEALTH VIRGINIA
Entity Type:Organization
Organization Name:SYNCHRONY HEALTH VIRGINIA
Other - Org Name:AWLS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:INFO
Authorized Official - Middle Name:
Authorized Official - Last Name:AWLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-639-5529
Mailing Address - Street 1:PO BOX 1048
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:VA
Mailing Address - Zip Code:22066-9048
Mailing Address - Country:US
Mailing Address - Phone:703-639-5529
Mailing Address - Fax:703-444-4308
Practice Address - Street 1:1850 TOWN CENTER PKWY
Practice Address - Street 2:303
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-3219
Practice Address - Country:US
Practice Address - Phone:703-639-5529
Practice Address - Fax:703-444-4308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-18
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty