Provider Demographics
NPI:1689767683
Name:SLEEP DISORDERS CTRS OF THE MID ATLANTIC LLC
Entity Type:Organization
Organization Name:SLEEP DISORDERS CTRS OF THE MID ATLANTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:PERLSTROM
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:703-752-7881
Mailing Address - Street 1:2235 CEDAR LN
Mailing Address - Street 2:SUITE 202
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-5202
Mailing Address - Country:US
Mailing Address - Phone:703-752-7881
Mailing Address - Fax:703-752-7880
Practice Address - Street 1:2235 CEDAR LN
Practice Address - Street 2:SUITE 202
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-5247
Practice Address - Country:US
Practice Address - Phone:703-752-7881
Practice Address - Fax:703-752-7880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2009-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810002163174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCG01143Medicare PIN
MD141366Medicare PIN
VA5549920001Medicare NSC