Provider Demographics
NPI:1447684691
Name:VIRGINIA ENDOCRINOLOGY CONSULTANTS
Entity type:Organization
Organization Name:VIRGINIA ENDOCRINOLOGY CONSULTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ENDOCRINOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:HAZEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:BOWEN-WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-676-3433
Mailing Address - Street 1:3022 JAVIER RD
Mailing Address - Street 2:SUITES 105G
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4645
Mailing Address - Country:US
Mailing Address - Phone:703-676-3433
Mailing Address - Fax:703-676-3438
Practice Address - Street 1:3022 JAVIER RD
Practice Address - Street 2:SUITES 105G
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4645
Practice Address - Country:US
Practice Address - Phone:703-676-3433
Practice Address - Fax:703-676-3438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-23
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101235232261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD407289800Medicaid