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1013618255
REVIVE MEDICINE LLC
FAIRFAX, VA
NPI
1013618255
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Entity Type
Organization
Authorized Contact
NANCY SELIM
Principal
951-741-7258
Organization Subpart ?
No
Primary Taxonomy
207QB0002X Family Medicine, Bariatric Medicine
Enumeration Date
2023-03-14
Last Update Date
2023-03-14
Business Address
REVIVE MEDICINE LLC
3998 FAIR RIDGE DR STE 270
FAIRFAX, VA 22033-2907
Phone number: 571-544-8110
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Mailing Address
REVIVE MEDICINE LLC
5423 MARLSTONE LN
FAIRFAX, VA 22030-5834
Phone number: 951-741-7258
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