Healthcare Provider Details

I. General information

NPI: 1326596479
Provider Name (Legal Business Name): WASHINGTON EAR ASSOCIATES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2016
Last Update Date: 11/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1093 BONNIE VIEW DR
GREAT FALLS VA
22066-1821
US

IV. Provider business mailing address

19450 DEERFIELD AVE SUITE 400
LEESBURG VA
20176-6820
US

V. Phone/Fax

Practice location:
  • Phone: 267-317-6227
  • Fax:
Mailing address:
  • Phone: 267-317-6227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0901X
TaxonomyOtology & Neurotology Physician
License Number0101254181
License Number StateVA

VIII. Authorized Official

Name: DR. ROYA AZADARMAKI
Title or Position: FOUNDER/PHYSICIAN
Credential: M.D.
Phone: 267-317-6227