| NPI | 1164052189 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | COURTNEY IVESS Associate Director, Credentialing 571-366-8831 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 207Q00000X Family Medicine |
| Enumeration Date | 2020-01-17 |
| Last Update Date | 2020-01-17 |