| NPI | 1164874426 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | COURTNEY IVESS Credentialing & Enrollment Manager 571-366-8831 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 208000000X Pediatrics |
| Enumeration Date | 2016-07-11 |
| Last Update Date | 2016-11-30 |