1174712301 NPI number — CONNIE D. LE, M.D, P.C

Table of content: (NPI 1174712301)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174712301 NPI number — CONNIE D. LE, M.D, P.C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CONNIE D. LE, M.D, P.C
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174712301
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/24/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4208 EVERGREEN LN
Provider Second Line Business Mailing Address:
SUITE 214
Provider Business Mailing Address City Name:
ANNANDALE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22003-3235
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-642-6633
Provider Business Mailing Address Fax Number:
703-642-6699

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4208 EVERGREEN LN
Provider Second Line Business Practice Location Address:
SUITE 214
Provider Business Practice Location Address City Name:
ANNANDALE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22003-3235
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-642-6633
Provider Business Practice Location Address Fax Number:
703-642-6699
Provider Enumeration Date:
10/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LE
Authorized Official First Name:
CONNIE
Authorized Official Middle Name:
D
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
703-642-6633

Provider Taxonomy Codes

  • Taxonomy code: 302F00000X , with the licence number:  0101237697 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 178649 . This is a "UNICARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 2536483 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 9166111 . This is a "CIGNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: K8390001 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 720471 . This is a "NCPPO, HEALTH LINK" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 9389238 . This is a "PHCS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 178649 . This is a "ANTHEM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 7120704 . This is a "AETNA NON HMO" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 3850929 . This is a "AETNA HMO" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 9389238 . This is a "A;LIED BENEFIT SYSTEM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 9389238 . This is a "JOHN ALDEN LIFE INSURANCE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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