Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 0101028478 | VA |
NPI | 1003814534 |
---|---|
Provider Name | Dr. David Benjamin Summer |
First Address | Fairfax, VA 22031-4637 |
Second Address | Fairfax, VA 22031-4637 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2005 |
Last Update Date | 01/02/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
006370675 | (05) | VA |
045888YT07 | PTAN (01) | VA |
045888ZFY4 | GROUP MEMBER PTAN (01) | VA |
C61629 | (02) | VA |