Individual provider Active NPI

Wallace Edgar Lawson, CRNA

  • Certified Registered Nurse Anesthetist
  • Manassas, VA
National Provider Identifier
1609985241
Registry record updated Mar 7, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
24116782 Issued in VA
Practice address
8700 Sudley Road
Manassas, VA 20110-4418
Phone
(571) 437-4334
NPI assigned
Aug 29, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 7, 2011

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 24116782 VA Primary
Certified Registered Nurse Anesthetist 367500000X AC000817 MD

Addresses

Primary practice location

8700 Sudley Road
Manassas, VA 20110-4418

Mailing address

8323 Suffolk Way
Gainesville, VA 20155-1778
Phone (571) 437-4334

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070511000106 VA Practitioner - Certified Registered Nurse Anesthetist (Crna) 6406952274 Reassigns benefits to 3 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse

State licenses

LicenseStateTypeSpecialty
AC000817MDMDCertified Registered Nurse Anesthetist
24116782VAMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Anesthesia Dynamics LLC Nurse Anesthetist, Certified Registered CurrentSince Apr 22, 2023 Accepting new patients
American Anesthesiology of Virginia PC Current Accepting new patients
American Anesthesiology of Virginia, PC CurrentSince Jun 30, 2015 Accepting new patients
Medstream Anesthesia PLLC Nurse Anesthetist, Certified Registered CurrentSince Mar 1, 2021 Accepting new patients

Locations

1211 Central Park Blvd
Fredericksburg, VA 22401
Phone (267) 742-8283

19455 Deerfield Ave
Ste 204
Leesburg, VA 20176
Phone (703) 724-9950

8700 Sudley Rd
Manassas, VA 20110
Phone (703) 369-8000

6801 Governor Gc Peery Hwy
Richlands, VA 24641
Phone (276) 523-8600

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1156809600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1299456000000",
    "number": "1609985241",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8323 SUFFOLK WAY",
            "city": "GAINESVILLE",
            "state": "VA",
            "postal_code": "201551778",
            "telephone_number": "571-437-4334",
            "fax_number": "703-754-3185"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8700 SUDLEY ROAD",
            "city": "MANASSAS",
            "state": "VA",
            "postal_code": "201104418",
            "telephone_number": "571-437-4334"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAWSON",
        "first_name": "WALLACE",
        "middle_name": "EDGAR",
        "name_prefix": "Mr.",
        "credential": "CRNA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-29",
        "last_updated": "2011-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "VA",
            "license": "24116782",
            "primary": true
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MD",
            "license": "AC000817",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Manassas, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.