Avicenna Health & Medical LLC
Internal Medicine in Reston, VA. Organization (NPI-2).
NPI number1083150239
StatusActive
Last updated in NPPESApr 15, 2019
Details
- NPI
- 1083150239
- Entity type
- Organization (NPI-2)
- Legal business name
- Avicenna Health & Medical LLC
- Organization subpart
- No
- Enumeration date
- Jan 11, 2017
- Last updated
- Apr 15, 2019
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207R00000X | Internal Medicine | 0101251555 | VA | Yes |
Practice location
1860 Town Center Dr Ste 340Reston, VA 20190-5912
Phone 703-943-7475
Mailing address
Po Box 2695Reston, VA 20195-0695
Phone 703-943-7475
Authorized official
Malika Manyam
President
8103413295
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