Provider Demographics
NPI:1336181882
Name:INFECTIOUS DISEASES SPECIALISTS OF VIRGINIA, LLC
Entity type:Organization
Organization Name:INFECTIOUS DISEASES SPECIALISTS OF VIRGINIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARIANN
Authorized Official - Middle Name:E
Authorized Official - Last Name:LANSDOWNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-758-2664
Mailing Address - Street 1:13890 BRADDOCK RD STE 206
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20121-2437
Mailing Address - Country:US
Mailing Address - Phone:703-758-2664
Mailing Address - Fax:703-758-2668
Practice Address - Street 1:13890 BRADDOCK RD STE 206
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20121-2437
Practice Address - Country:US
Practice Address - Phone:703-758-2664
Practice Address - Fax:703-758-2668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCG00559Medicare PIN
VAC06917Medicare PIN