Provider Demographics
NPI:1750376539
Name:LAILAS, NICHOLAS GEORGE (MD)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:GEORGE
Last Name:LAILAS
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 1:224 D CORNWALL STREET NW
Mailing Address - Street 2:STE 403
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-2704
Mailing Address - Country:US
Mailing Address - Phone:703-737-6010
Mailing Address - Fax:703-443-8643
Practice Address - Street 1:1860 TOWN CENTER DRIVE, SUITE 150
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-5905
Practice Address - Country:US
Practice Address - Phone:703-480-0220
Practice Address - Fax:703-480-0280
Is Sole Proprietor?:No
Enumeration Date:2005-09-16
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101054583208800000X
DCMD22055208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA340017875OtherRR MEDICARE VA
DC340017876OtherRRMEDICARE
VA1750376539Medicaid
VA30016055850001Medicaid
DC340017876OtherRRMEDICARE
VA340000660Medicare PIN
DC340017876OtherRRMEDICARE