Provider Demographics
NPI:1710054457
Name:BARTIS, LOIS C (MD)
Entity Type:Individual
Prefix:
First Name:LOIS
Middle Name:C
Last Name:BARTIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 CHAIN BRIDGE RD
Mailing Address - Street 2:SUITE 312
Mailing Address - City:MCLEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-4451
Mailing Address - Country:US
Mailing Address - Phone:703-847-9800
Mailing Address - Fax:703-821-3465
Practice Address - Street 1:1515 CHAIN BRIDGE RD
Practice Address - Street 2:SUITE 312
Practice Address - City:MCLEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-4451
Practice Address - Country:US
Practice Address - Phone:703-847-9800
Practice Address - Fax:703-821-3465
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101032581207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
B93772Medicare UPIN
BA159793Medicare ID - Type Unspecified