| NPI | 1356916506 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KATE BOGUE Credentialing 703-776-0108 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM1300X Clinic/Center, Multi-Specialty |
| Additional Taxonomies | 207R00000X Internal Medicine |
| 2085R0202X Radiology, Diagnostic Radiology | |
| 2085U0001X Radiology, Diagnostic Ultrasound | |
| 213ER0200X Podiatrist, Radiology | |
| Enumeration Date | 2021-05-20 |
| Last Update Date | 2022-08-06 |