Organization Name: | INTERNAL MEDICINE PRACTICE, P.C. |
NPI Number: | 1013121508 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | SANDRA TIRADO (PHYSICIAN) |
Mailing Address: | 8233 Old Courthouse Rd Suite 170 Vienna |
State: | VA US |
Postal Code: | 221823816 |
Phone Number: | 7035569318 |
Fax Number: | 7034488839 |
NPI Enumeration Date: | 05/10/2007 |
NPI Last Update Date: | 07/14/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QP2300X |
License Number: | 0101038420 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | VA |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Primary Care |
Taxonomy Definition: |