Healthcare Provider Details

I. General information

NPI: 1114129574
Provider Name (Legal Business Name): HEMATOLOGY ONCOLOGY ASSOC LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5226 DAWES AVENUE
ALEXANDRIA VA
22311
US

IV. Provider business mailing address

5226 DAWES AVENUE
ALEXANDRIA VA
22311
US

V. Phone/Fax

Practice location:
  • Phone: 703-379-9111
  • Fax: 703-931-7952
Mailing address:
  • Phone: 703-379-9111
  • Fax: 703-931-7952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number0101018898
License Number StateVA

VIII. Authorized Official

Name: LEROY F SMITH JR.
Title or Position: PRESIDENT
Credential: MD
Phone: 703-379-9111