MEDICARE: DR. WILLIAM SYMS STAGE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	0101032640	VA
2	2084P0804X	Child & Adolescent Psychiatry Physician	0101032640	VA

General Provider Information

NPI Number	:	1417100959
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM SYMS STAGE M.D.

Provider Business Mailing Address
First Line	:	6020 RICHMOND HWY
Second Line	:	SUITE 200
City	:	ALEXANDRIA
State	:	VA
Zip	:	22303-2157
Country	:	US
Telephone Number	:	703-683-5085
Fax Number	:

Provider Business Practice Location Address
First Line	:	6020 RICHMOND HWY
Second Line	:	SUITE 200
City	:	ALEXANDRIA
State	:	VA
Zip	:	22303-2157
Country	:	US
Telephone Number	:	703-683-5085
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/28/2008
Last Update Date	:	10/28/2008

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