| Lake Manassas Medical Psychiatry | |
|
7544 Gardner Park Dr Gainesville VA 20155-3414 | |
| (703) 772-7400 | |
| (703) 940-9179 |
| Full Name | Lake Manassas Medical Psychiatry |
|---|---|
| Speciality | Psychiatry & Neurology - Psychiatry |
| Location | 7544 Gardner Park Dr, Gainesville, Virginia |
| Authorized Official Name and Position | Craig Charles Krause (SOLE MEMBER) |
| Authorized Official Contact | 7037727400 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Lake Manassas Medical Psychiatry 7544 Gardner Park Dr Gainesville VA 20155-3414 Ph: (703) 772-7400 | Lake Manassas Medical Psychiatry 7544 Gardner Park Dr Gainesville VA 20155-3414 Ph: (703) 772-7400 |
| NPI Number | 1588722425 |
|---|---|
| Provider Enumeration Date | 12/04/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588722425 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | 0101233772 (Virginia) | Primary |
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