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General NPI Number Information
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NPI Number | 1184719452
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Entity Type | Organization
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Legal Business Name | DIGESTIVE HEALTH ASSOCIATES PC
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Dates
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Enumeration Date | 10/04/2006
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Last Update Date | 02/19/2010
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Provider Practice Location Address
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Address Line | 4660 KENMORE AVE STE 200
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City | ALEXANDRIA
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State | VA
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Zip | 22304-1306
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Country | US
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Telephone | 703-823-3750
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Fax | 703-823-3766
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Provider Business Mailing Address
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Address Line | 4660 KENMORE AVE STE 200
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City | ALEXANDRIA
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State | VA
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Zip | 22304-1306
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Country | US
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Telephone | 703-823-3750
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Fax | 703-823-3766
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | JANE CHUNG
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Credential |
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Telephone | 703-823-3750
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 34071-01
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License Number State | VA
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