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General NPI Number Information
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NPI Number | 1174712301
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Entity Type | Organization
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Legal Business Name | CONNIE D. LE, M.D, P.C
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Dates
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Enumeration Date | 10/24/2007
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Last Update Date | 10/24/2007
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Provider Practice Location Address
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Address Line | 4208 EVERGREEN LN SUITE 214
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City | ANNANDALE
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State | VA
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Zip | 22003-3235
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Country | US
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Telephone | 703-642-6633
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Fax | 703-642-6699
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Provider Business Mailing Address
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Address Line | 4208 EVERGREEN LN SUITE 214
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City | ANNANDALE
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State | VA
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Zip | 22003-3235
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Country | US
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Telephone | 703-642-6633
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Fax | 703-642-6699
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Authorized Official
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Title or Position | PRESIDENT
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Name | CONNIE D LE
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Credential | M.D.
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Telephone | 703-642-6633
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | 0101237697
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License Number State | VA
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