Provider Demographics
NPI:1760588628
Name:EAR NOSE & THROAT SPECIALISTS OF NORTHERN VA
Entity Type:Organization
Organization Name:EAR NOSE & THROAT SPECIALISTS OF NORTHERN VA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSH
Authorized Official - Middle Name:P
Authorized Official - Last Name:OPPENHEIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-536-2729
Mailing Address - Street 1:6231 LEESBURG PIKE
Mailing Address - Street 2:500
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22044-2102
Mailing Address - Country:US
Mailing Address - Phone:703-536-2729
Mailing Address - Fax:703-241-0381
Practice Address - Street 1:6231 LEESBURG PIKE
Practice Address - Street 2:500
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22044-2102
Practice Address - Country:US
Practice Address - Phone:703-536-2729
Practice Address - Fax:703-241-0381
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101016929207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0823OtherCARE FIRST BLUE CROSS
VA0823OtherCARE FIRST BLUE CROSS
VAC06149Medicare PIN
VAC05288Medicare PIN