Healthcare Provider Details

I. General information

NPI: 1043268816
Provider Name (Legal Business Name): WASHINGTON METRO PULMONARY L L C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 10/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7611 LITTLE RIVER TPKE SUITE 108 W
ANNANDALE VA
22003-2602
US

IV. Provider business mailing address

7611 LITTLE RIVER TPKE SUITE 108 W
ANNANDALE VA
22003-2602
US

V. Phone/Fax

Practice location:
  • Phone: 703-658-7060
  • Fax: 703-658-3150
Mailing address:
  • Phone: 703-658-7060
  • Fax: 703-658-3150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number0101049539
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number0101049539
License Number StateVA

VIII. Authorized Official

Name: THIEU M DO
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 703-658-7060