Provider Demographics
NPI:1336338276
Name:DR. ELENI SOLOS-KOUNTOURIS, PC
Entity Type:Organization
Organization Name:DR. ELENI SOLOS-KOUNTOURIS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ELENI
Authorized Official - Middle Name:
Authorized Official - Last Name:SOLOS-KOUNTOURIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-378-8994
Mailing Address - Street 1:13880 BRADDOCK RD
Mailing Address - Street 2:SUITE 307
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20121-2459
Mailing Address - Country:US
Mailing Address - Phone:703-378-8994
Mailing Address - Fax:703-378-7911
Practice Address - Street 1:13880 BRADDOCK RD
Practice Address - Street 2:SUITE 307
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20121-2459
Practice Address - Country:US
Practice Address - Phone:703-378-8994
Practice Address - Fax:703-378-7911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-16
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101058312174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAG02653Medicare PIN