| NPI | 1811171309 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHAQUWANDA BAKER Office Manager 703-323-4093 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RG0300X Internal Medicine, Geriatric Medicine (Licence: VA 0101233274) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: VA 0101040712) |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: VA 0101046923) | |
| 2084P0005X Psychiatry & Neurology, Neurodevelopmental Disabilities (Licence: VA 0101034545) | |
| Enumeration Date | 2007-12-20 |
| Last Update Date | 2008-06-19 |