| Organization Name: | CENTREVILLE INTERNAL MEDICINE |
| NPI Number: | 1073712352 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | SUGKEE YOUN (DIRECTOR) |
| Mailing Address: | 13880 Braddock Rd Ste 107 Centreville |
| State: | VA US |
| Postal Code: | 201212460 |
| Phone Number: | 7039650180 |
| Fax Number: | 7032669003 |
| NPI Enumeration Date: | 07/16/2007 |
| NPI Last Update Date: | 08/09/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QA0600X |
| License Number: | 0101235830 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | VA |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Adult Day Care |
| Taxonomy Definition: | |