NPIMap

Organization Active NPI

Chantilly Specialists, LTD. of Virginia

  • Clinical Medical Laboratory
  • Chantilly, VA
National Provider Identifier
1376853341
Registry record updated Oct 8, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
License
49D2006729 Issued in VA
Legal business name
CHANTILLY SPECIALISTS, LTD. OF VIRGINIA
Practice address
14121 Parke Long CT
Suite 112
Chantilly, VA 20151-1647
Phone
(571) 251-5471
Fax
(703) 378-4909
NPI assigned
Oct 8, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 8, 2010

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

Authorized official

Name
Mr. Paul P Boccone, J.D., LL.M.
Title
President
Phone
(571) 251-5471

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Medical Laboratory 291U00000X 49D2006729 VA Primary

Addresses

Primary practice location

14121 Parke Long CT
Suite 112
Chantilly, VA 20151-1647

Mailing address

14121 Parke Long CT
Suite 112
Chantilly, VA 20151-1647
Phone (571) 251-5471

National Provider Directory

National Provider Directory

Locations

4200 Lafayette Center Dr
Ste R
Chantilly, VA 20151
Phone (703) 378-3854

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1286496000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1286496000000",
    "number": "1376853341",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14121 PARKE LONG CT",
            "address_2": "SUITE 112",
            "city": "CHANTILLY",
            "state": "VA",
            "postal_code": "201511647",
            "telephone_number": "571-251-5471",
            "fax_number": "703-378-4909"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14121 PARKE LONG CT",
            "address_2": "SUITE 112",
            "city": "CHANTILLY",
            "state": "VA",
            "postal_code": "201511647",
            "telephone_number": "571-251-5471",
            "fax_number": "703-378-4909"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHANTILLY SPECIALISTS, LTD. OF VIRGINIA",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-10-08",
        "last_updated": "2010-10-08",
        "status": "A",
        "authorized_official_last_name": "BOCCONE",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "571-251-5471",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "J.D., LL.M."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "VA",
            "license": "49D2006729",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chantilly, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2010; 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.