Organization
ENT NEONATAL OF NORTHERN VIRGINIA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KEN HENRY PH.D. (MEDICAL DIRECTOR, ENT NEONATAL)
(703) 536-1666
Entity
Organization
Contact information
Practice address
8314 TRAFORD LN, LOWER LEVEL, SPRINGFIELD, VA 22152-1651
(703) 451-0973
(703) 644-4643
Mailing address
8314 TRAFORD LN, LOWER LEVEL, SPRINGFIELD, VA 22152-1651
(703) 451-0973
(703) 644-4643
Taxonomy
Speciality
Code
Description
License number
State
231H00000X
Audiologist
Primary
2201000526
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0734698
BUSINESS LICENSE
VA
Enumeration date
06/29/2007
Last updated
08/22/2020
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