| Organization Name: | NORTHERN VIRGINIA INTERNAL MEDICINE AND PEDIATRICS, P.C |
| NPI Number: | 1942484894 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MARY ELLEN GALLAGHER (CHEIF MEDICAL OFFICER) |
| Mailing Address: | 2501 N Glebe Rd #301 Arlington |
| State: | VA US |
| Postal Code: | 222073558 |
| Phone Number: | 7035276664 |
| Fax Number: | 7035270655 |
| NPI Enumeration Date: | 12/27/2007 |
| NPI Last Update Date: | 03/06/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 0101235679 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | VA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |