# ENT NEONATAL OF NORTHERN VIRGINIA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1598962805
- **Authorized official:** KEN HENRY PH.D. (MEDICAL DIRECTOR, ENT NEONATAL)
- **Authorized official phone:** (703) 536-1666

## Contact information

- **Practice address:** 8314 TRAFORD LN, LOWER LEVEL, SPRINGFIELD, VA 22152-1651
- **Practice address phone:** (703) 451-0973
- **Practice address fax:** (703) 644-4643
- **Mailing address:** 8314 TRAFORD LN, LOWER LEVEL, SPRINGFIELD, VA 22152-1651
- **Mailing address phone:** (703) 451-0973
- **Mailing address fax:** (703) 644-4643

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 231H00000X | Audiologist | 2201000526 | VA | Yes |

## Other

- **Enumeration date:** 06/29/2007
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0734698 | BUSINESS LICENSE | VA |