Organization
CHANTILLY SPECIALISTS, LTD. OF VIRGINIA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PAUL P BOCCONE J.D., LL.M. (PRESIDENT)
(571) 251-5471
Entity
Organization
Contact information
Practice address
14121 PARKE LONG CT, SUITE 112, CHANTILLY, VA 20151-1647
(571) 251-5471
(703) 378-4909
Mailing address
14121 PARKE LONG CT, SUITE 112, CHANTILLY, VA 20151-1647
(571) 251-5471
(703) 378-4909
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
49D2006729
VA
Other
Enumeration date
10/08/2010
Last updated
10/08/2010
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