MEDICARE: IT IS ENT, PLLC

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	207Y00000X	Otolaryngology Physician	0101256962	VA

General Provider Information

NPI Number	:	1497280739
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IT IS ENT, PLLC

Provider Business Mailing Address
First Line	:	PO BOX 30904
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22310-8904
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2210 MOUNT VERNON AVE
Second Line	:	SUITE 205
City	:	ALEXANDRIA
State	:	VA
Zip	:	22301-1361
Country	:	US
Telephone Number	:	571-447-9136
Fax Number	:

Authorized Official
Title or Position	:	PRINCIPAL
Name	:	ESTELLE YOO
Credential	:
Telephone Number	:	571-447-9136

Provider Enumeration Date	:	04/24/2017
Last Update Date	:	04/24/2017

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