Organization
CHANTILLY SPECIALISTS, LTD. OF VIRGINIA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PAUL BOCCONE J.D., LL.M. (PRESIDENT)
(703) 378-3854
Entity
Organization
Contact information
Practice address
4200 LAFAYETTE CENTER DR, STE R, CHANTILLY, VA 20151-1241
(703) 378-3854
(703) 378-4909
Mailing address
4200 LAFAYETTE CENTER DR, STE R, CHANTILLY, VA 20151-1241
(703) 378-3854
(703) 378-4909
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
208VP0000X
Pain Medicine Physician
Primary
—
—
Other
Enumeration date
03/25/2010
Last updated
02/22/2011
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