Healthcare Provider Details

I. General information

NPI: 1306939699
Provider Name (Legal Business Name): ASSOCIATES IN OTOLARYNGOLOGY HEAD AND NECK SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6355 WALKER LN SUITE 411
ALEXANDRIA VA
22310-3245
US

IV. Provider business mailing address

6355 WALKER LN SUITE 411
ALEXANDRIA VA
22310-3245
US

V. Phone/Fax

Practice location:
  • Phone: 703-313-0373
  • Fax: 703-719-0400
Mailing address:
  • Phone: 703-313-0373
  • Fax: 703-719-0400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL JAY NATHAN
Title or Position: DOCTOR
Credential: M.D.
Phone: 703-313-0373