Provider Demographics
NPI:1891116059
Name:ALLERGY ASTHMA & IMMUNOLOGY INSTITUTE
Entity Type:Organization
Organization Name:ALLERGY ASTHMA & IMMUNOLOGY INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:ISPAS-PONAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:571-399-5132
Mailing Address - Street 1:19455 DEERFIELD AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:LANSDOWNE
Mailing Address - State:VA
Mailing Address - Zip Code:20176-8100
Mailing Address - Country:US
Mailing Address - Phone:571-399-5132
Mailing Address - Fax:703-723-9800
Practice Address - Street 1:19455 DEERFIELD AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:LANSDOWNE
Practice Address - State:VA
Practice Address - Zip Code:20176-8100
Practice Address - Country:US
Practice Address - Phone:571-399-5132
Practice Address - Fax:703-723-9800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-13
Last Update Date:2016-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101249276207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty