Provider Demographics
NPI:1669778080
Name:JOHN W KLOUSIA MD PC
Entity type:Organization
Organization Name:JOHN W KLOUSIA MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:WIFE
Authorized Official - Prefix:MRS
Authorized Official - First Name:LEE
Authorized Official - Middle Name:
Authorized Official - Last Name:KLOUSIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-402-7073
Mailing Address - Street 1:306 WOODLAND TER
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22302-3313
Mailing Address - Country:US
Mailing Address - Phone:703-402-7073
Mailing Address - Fax:
Practice Address - Street 1:7910 ANDRUS RD
Practice Address - Street 2:SUITE 6
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22306-3171
Practice Address - Country:US
Practice Address - Phone:703-780-5474
Practice Address - Fax:703-799-4092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-02
Last Update Date:2011-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
127035OtherMEDICARE ID
VA010273404Medicaid
G02282N05Medicare PIN
127035OtherMEDICARE ID