Provider Demographics
NPI:1184711483
Name:HO, DAVID K L (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:K L
Last Name:HO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 SOUTH WASHINGTON STREET
Mailing Address - Street 2:SUITE 6B
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-3631
Mailing Address - Country:US
Mailing Address - Phone:703-683-0999
Mailing Address - Fax:703-836-7120
Practice Address - Street 1:312 SOUTH WASHINGTON STREET
Practice Address - Street 2:SUITE 6B
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-3631
Practice Address - Country:US
Practice Address - Phone:703-683-0999
Practice Address - Fax:703-836-7120
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2010-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101058494207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
158253OtherMEDICARE PROVIDER GROUP
VA5843782Medicaid
158253OtherMEDICARE PROVIDER GROUP
G89804Medicare UPIN