Healthcare Provider Details

I. General information

NPI: 1689423915
Provider Name (Legal Business Name): VIRGINIA ALLERGY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2024
Last Update Date: 05/17/2024
Certification Date: 05/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10134 COLVIN RUN RD STE D
GREAT FALLS VA
22066-1841
US

IV. Provider business mailing address

10134 COLVIN RUN RD STE D
GREAT FALLS VA
22066-1841
US

V. Phone/Fax

Practice location:
  • Phone: 703-757-7950
  • Fax: 703-757-7953
Mailing address:
  • Phone: 703-757-7950
  • Fax: 703-757-7953

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MANUEL GUILLEN
Title or Position: PRESIDENT
Credential: MD
Phone: 703-932-7335