MEDICARE: PEDIATRICS OF SEVEN CORNERS LLC

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	208000000X	Pediatrics Physician

General Provider Information

NPI Number	:	1952178550
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEDIATRICS OF SEVEN CORNERS LLC

Provider Business Mailing Address
First Line	:	6404 SEVEN CORNERS PL STE K
Second Line	:
City	:	FALLS CHURCH
State	:	VA
Zip	:	22044-2034
Country	:	US
Telephone Number	:	703-536-8864
Fax Number	:	703-536-4290

Provider Business Practice Location Address
First Line	:	6404 SEVEN CORNERS PL STE K
Second Line	:
City	:	FALLS CHURCH
State	:	VA
Zip	:	22044-2034
Country	:	US
Telephone Number	:	703-536-8864
Fax Number	:	703-536-4290

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. LAMSON DANG NGUYEN
Credential	:	DO
Telephone Number	:	703-536-8864

Provider Enumeration Date	:	12/05/2023
Last Update Date	:	12/05/2023

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