Dalewood Medical ENT

Primary specialty

Legal MedicineTaxonomy code 173000000X

Legal business name

DALEWOOD MEDICAL ENT

Practice address

4158 Dale Blvd
Dale City, VA 22193-2225

Phone

(703) 680-5959

Fax

(703) 730-1046

NPI assigned

Jul 14, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jennifer Kulak

Title

Office Manager

Phone

(703) 680-5959

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152835200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1198713600000",
    "number": "1174549265",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4158 DALE BLVD",
            "city": "DALE CITY",
            "state": "VA",
            "postal_code": "221932225",
            "telephone_number": "703-680-5959",
            "fax_number": "703-730-1046"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4158 DALE BLVD",
            "city": "DALE CITY",
            "state": "VA",
            "postal_code": "221932225",
            "telephone_number": "703-680-5959",
            "fax_number": "703-730-1046"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DALEWOOD MEDICAL ENT",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-14",
        "last_updated": "2007-12-27",
        "status": "A",
        "authorized_official_last_name": "KULAK",
        "authorized_official_first_name": "JENNIFER",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "703-680-5959"
    },
    "taxonomies": [
        {
            "code": "173000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Legal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Legal Medicine in Dale City, VA
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.