Organization
OLDE TOWN ANESTHESIA ASSOCIATES, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ROBERT LEE LYLES JR. MD, PHD (PRESIDENT)
(703) 820-6418
Entity
Organization
Contact information
Practice address
4000 MITCHELLVILLE RD, SUITE B322, BOWIE, MD 20716-3104
(703) 820-6418
Mailing address
4520 KING ST, ALEXANDRIA, VA 22302-1347
(703) 820-6418
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
0101035966
VA
Other
Enumeration date
03/14/2007
Last updated
08/22/2020
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