Provider Demographics
NPI:1659692598
Name:COSMOSMD
Entity Type:Organization
Organization Name:COSMOSMD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:NGOC
Authorized Official - Middle Name:HAI
Authorized Official - Last Name:LE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-477-8917
Mailing Address - Street 1:8991 COTSWOLD DR STE 3A
Mailing Address - Street 2:
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22015-1663
Mailing Address - Country:US
Mailing Address - Phone:703-477-8917
Mailing Address - Fax:
Practice Address - Street 1:8991 COTSWOLD DR STE 3A
Practice Address - Street 2:
Practice Address - City:BURKE
Practice Address - State:VA
Practice Address - Zip Code:22015-1663
Practice Address - Country:US
Practice Address - Phone:703-477-8917
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-15
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1047335261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care