Basic Information
| Provider Information | |||||||||
| NPI: | 1881187458 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SENG | ||||||||
| FirstName: | VINCENT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4040 CENTER OAK PLAZA | ||||||||
| Address2: | SUITE 150 | ||||||||
| City: | STERLING | ||||||||
| State: | VA | ||||||||
| PostalCode: | 20166 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7039979494 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4040 CENTER OAK PLAZA | ||||||||
| Address2: | SUITE 150 | ||||||||
| City: | STERLING | ||||||||
| State: | VA | ||||||||
| PostalCode: | 20166 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7039979494 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2018 | ||||||||
| LastUpdateDate: | 06/08/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106S00000X | Y |
ID Information
| ID | Type | State | Issuer | Description | 059167260041 | 05 | VA | MEDICAID |