Provider Demographics
NPI:1891886909
Name:LE, CONNIE DIEM KHANH (MD)
Entity Type:Individual
Prefix:DR
First Name:CONNIE
Middle Name:DIEM KHANH
Last Name:LE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4208 EVERGREEN LN STE 214
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-3254
Mailing Address - Country:US
Mailing Address - Phone:703-642-6633
Mailing Address - Fax:703-642-6699
Practice Address - Street 1:4208 EVERGREEN LN STE 214
Practice Address - Street 2:
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-3254
Practice Address - Country:US
Practice Address - Phone:703-642-6633
Practice Address - Fax:703-642-6699
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101237697207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA202907076OtherTRICARE STANDARD
VA7120704OtherAETNA NON HMO
MD408479900Medicaid
VA9166111OtherCIGNA
VA178649OtherANTHEM PROVIDER ID #
VAK8390001OtherBLUE CROSS BLUE SHIELD
VA010189721Medicaid
VA2536483OtherUNITED HEALTH CARE
VA9389238OtherALLIED BENEFITS SYSTEM
DC036849700Medicaid
VA720471OtherNCPPO
VAG02045C01OtherMEDICARE PTAN
VA9389238OtherPHCS PROVIDER ID #
VAG02045C01OtherMEDICARE PTAN
VA9166111OtherCIGNA