Healthcare Provider Details

I. General information

NPI: 1770654113
Provider Name (Legal Business Name): VIRGINIA HEAD AND NECK SURGEONS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 04/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19455 DEERFIELD AVE SUITE 301
LANSDOWNE VA
20176-8102
US

IV. Provider business mailing address

19455 DEERFIELD AVE SUITE 301
LANSDOWNE VA
20176-8102
US

V. Phone/Fax

Practice location:
  • Phone: 703-858-4439
  • Fax: 703-858-4489
Mailing address:
  • Phone: 703-858-4439
  • Fax: 703-858-4489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License Number
License Number StateVA

VIII. Authorized Official

Name: ANDREW B SILVA
Title or Position: OWNER
Credential: MD
Phone: 703-858-4439