Provider Demographics
NPI:1053734194
Name:LE, JASON (DO)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:LE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1760 OLD MEADOW RD STE 220
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102-4330
Mailing Address - Country:US
Mailing Address - Phone:703-828-8066
Mailing Address - Fax:855-461-1618
Practice Address - Street 1:1760 OLD MEADOW RD STE 220
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22102-4330
Practice Address - Country:US
Practice Address - Phone:703-828-8066
Practice Address - Fax:855-461-1618
Is Sole Proprietor?:No
Enumeration Date:2014-01-24
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0102204241207QS0010X, 207QS0010X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program