Provider Demographics
NPI:1174712301
Name:CONNIE D. LE, M.D, P.C
Entity type:Organization
Organization Name:CONNIE D. LE, M.D, P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:D
Authorized Official - Last Name:LE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-642-6633
Mailing Address - Street 1:4208 EVERGREEN LN
Mailing Address - Street 2:SUITE 214
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-3235
Mailing Address - Country:US
Mailing Address - Phone:703-642-6633
Mailing Address - Fax:703-642-6699
Practice Address - Street 1:4208 EVERGREEN LN
Practice Address - Street 2:SUITE 214
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-3235
Practice Address - Country:US
Practice Address - Phone:703-642-6633
Practice Address - Fax:703-642-6699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-24
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101237697302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA178649OtherUNICARE
VA2536483OtherUNITED HEALTH CARE
VA9166111OtherCIGNA
VAK8390001OtherBLUE CROSS BLUE SHIELD
VA720471OtherNCPPO, HEALTH LINK
VA9389238OtherPHCS
VA178649OtherANTHEM
VA7120704OtherAETNA NON HMO
VA3850929OtherAETNA HMO
VA9389238OtherA;LIED BENEFIT SYSTEM
VA9389238OtherJOHN ALDEN LIFE INSURANCE
VA9389238OtherA;LIED BENEFIT SYSTEM