Healthcare Provider Details

I. General information

NPI: 1053734194
Provider Name (Legal Business Name): JASON LE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2014
Last Update Date: 07/03/2024
Certification Date: 07/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1760 OLD MEADOW RD STE 220
MC LEAN VA
22102-4330
US

IV. Provider business mailing address

1760 OLD MEADOW RD STE 220
MC LEAN VA
22102-4330
US

V. Phone/Fax

Practice location:
  • Phone: 703-828-8066
  • Fax: 855-461-1618
Mailing address:
  • Phone: 703-828-8066
  • Fax: 855-461-1618

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number0102204241
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: