Individual
NICHOLAS GEORGE LAILAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1860 TOWN CENTER DRIVE, SUITE 150, RESTON, VA 20190-5905
(703) 480-0220
(703) 480-0280
Mailing address
224 D CORNWALL STREET NW, STE 403, LEESBURG, VA 20176-2704
(703) 737-6010
(703) 443-8643
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
0101054583
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1750376539
—
VA
05
—
30016055850001
—
VA
01
—
340017875
RR MEDICARE VA
VA
01
—
340017876
RRMEDICARE
DC
Enumeration date
09/16/2005
Last updated
03/18/2024
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