Healthcare Provider Details

I. General information

NPI: 1891116059
Provider Name (Legal Business Name): ALLERGY ASTHMA & IMMUNOLOGY INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2013
Last Update Date: 04/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19455 DEERFIELD AVE SUITE 205
LANSDOWNE VA
20176-8100
US

IV. Provider business mailing address

19455 DEERFIELD AVE SUITE 205
LANSDOWNE VA
20176-8100
US

V. Phone/Fax

Practice location:
  • Phone: 571-399-5132
  • Fax: 703-723-9800
Mailing address:
  • Phone: 571-399-5132
  • Fax: 703-723-9800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number0101249276
License Number StateVA

VIII. Authorized Official

Name: DR. LAURA ISPAS-PONAS
Title or Position: CEO/PRESIDENT
Credential: M.D.
Phone: 571-399-5132