MEDICARE: ACCREDITED ALLERGY CENTER OF SPRINGFIELD, LTD

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	174400000X	Specialist	0101237445	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639371990
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACCREDITED ALLERGY CENTER OF SPRINGFIELD, LTD

Provider Business Mailing Address
First Line	:	8134 OLD KEENE MILL RD STE 301
Second Line	:
City	:	SPRINGFIELD
State	:	VA
Zip	:	22152-1849
Country	:	US
Telephone Number	:	703-569-1913
Fax Number	:	703-569-6035

Provider Business Practice Location Address
First Line	:	8134 OLD KEENE MILL RD STE 301
Second Line	:
City	:	SPRINGFIELD
State	:	VA
Zip	:	22152-1849
Country	:	US
Telephone Number	:	703-569-1913
Fax Number	:	703-569-6035

Authorized Official
Title or Position	:	PRACTICE ADMINISTRATOR
Name	:	TERESA TEAGUE
Credential	:
Telephone Number	:	703-569-1913

Provider Enumeration Date	:	05/31/2007
Last Update Date	:	08/22/2020

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