Provider Demographics
NPI:1043268816
Name:WASHINGTON METRO PULMONARY L L C
Entity type:Organization
Organization Name:WASHINGTON METRO PULMONARY L L C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:THIEU
Authorized Official - Middle Name:M
Authorized Official - Last Name:DO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-658-7060
Mailing Address - Street 1:7611 LITTLE RIVER TPKE
Mailing Address - Street 2:SUITE 108 W
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-2602
Mailing Address - Country:US
Mailing Address - Phone:703-658-7060
Mailing Address - Fax:703-658-3150
Practice Address - Street 1:7611 LITTLE RIVER TPKE
Practice Address - Street 2:SUITE 108 W
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-2602
Practice Address - Country:US
Practice Address - Phone:703-658-7060
Practice Address - Fax:703-658-3150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101049539207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005868157Medicaid
VA491149Medicare PIN
VAH51293Medicare UPIN