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Physicians Internal Medicine Adolescent Medicine

Provider NPI: 1730116575

Provider Information:
Gender: M
Not Sole Proprietor

Practice Location:
Tel: 703-489-0508  Fax: --

Business Mailing Address:
Tel: 703-489-0508  Fax: 703-468-1061

NPI Information:
NPI: 1730116575
Entity Type: Individual


PrimaryCodeCategory/DescriptionStateLicense Number
Internal Medicine
Adolescent Medicine

Other Provider Identifiers:


American Medical Association 2012 taxonomy code information

Code: 207RA0000X





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