Provider Demographics
NPI:1700147097
Name:LE, ANH-PHUONG (PA-C)
Entity Type:Individual
Prefix:MS
First Name:ANH-PHUONG
Middle Name:
Last Name:LE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7421 RENEE ST
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22315-3517
Mailing Address - Country:US
Mailing Address - Phone:571-451-4134
Mailing Address - Fax:
Practice Address - Street 1:3833 FAIRFAX DR STE 200
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22203-1773
Practice Address - Country:US
Practice Address - Phone:703-525-8863
Practice Address - Fax:571-748-4257
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-03
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110003864363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant