Provider Demographics
NPI:1356357578
Name:STEVEN J PEREZ MD PC
Entity type:Organization
Organization Name:STEVEN J PEREZ MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-914-3640
Mailing Address - Street 1:6715 LITTLE RIVER TPKE
Mailing Address - Street 2:201
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-3546
Mailing Address - Country:US
Mailing Address - Phone:703-914-3640
Mailing Address - Fax:703-914-2536
Practice Address - Street 1:6715 LITTLE RIVER TPKE
Practice Address - Street 2:201
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-3546
Practice Address - Country:US
Practice Address - Phone:703-914-3640
Practice Address - Fax:703-914-2536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101237477207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1164428231OtherINDIVIDUAL NPI
VAE64898Medicare UPIN
VAG02376Medicare PIN