Provider Demographics
NPI:1174517478
Name:SIRLIN, SCOTT MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:MICHAEL
Last Name:SIRLIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:19455 DEERFIELD AVE
Mailing Address - Street 2:SUITE 205
Mailing Address - City:LANSDOWNE
Mailing Address - State:VA
Mailing Address - Zip Code:20176-8100
Mailing Address - Country:US
Mailing Address - Phone:703-726-9930
Mailing Address - Fax:703-723-8278
Practice Address - Street 1:19455 DEERFIELD AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:LANSDOWNE
Practice Address - State:VA
Practice Address - Zip Code:20176-8100
Practice Address - Country:US
Practice Address - Phone:703-726-9930
Practice Address - Fax:703-723-8278
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-01
Last Update Date:2009-08-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA01012257892080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA06734626Medicaid
VA013109L19Medicare PIN
VA06734626Medicaid