Provider Demographics
NPI:1386066520
Name:WEST LAKE INTERNAL MEDICINE
Entity type:Organization
Organization Name:WEST LAKE INTERNAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DEL PIERRO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:571-375-0016
Mailing Address - Street 1:21047 STANFORD SQ
Mailing Address - Street 2:401
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20166-2457
Mailing Address - Country:US
Mailing Address - Phone:571-375-0016
Mailing Address - Fax:571-375-0073
Practice Address - Street 1:46175 WESTLAKE DR
Practice Address - Street 2:STE 440
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20165-5873
Practice Address - Country:US
Practice Address - Phone:571-375-0016
Practice Address - Fax:571-375-0073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-07
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101235464207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty