| Chantilly Walk-in Clinic | |
|
13037 Lee Jackson Hwy Ste D Fairfax VA 22033-2004 | |
| (703) 631-0791 | |
| (703) 968-4227 |
| Full Name | Chantilly Walk-in Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 13037 Lee Jackson Hwy, Fairfax, Virginia |
| Authorized Official Name and Position | Samir Nazam (PHYSICIAN) |
| Authorized Official Contact | 7036310791 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Chantilly Walk-in Clinic Po Box 221226 Chantilly VA 20153-1226 Ph: (703) 631-0791 | Chantilly Walk-in Clinic 13037 Lee Jackson Hwy Ste D Fairfax VA 22033-2004 Ph: (703) 631-0791 |
| NPI Number | 1972509735 |
|---|---|
| Provider Enumeration Date | 06/24/2005 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 4183771983 |
|---|---|
| Medicare Enrollment ID | O20090414000430 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1972509735 | NPI | - | NPPES |
| 292549 | Other | VA | B/C PROVIDER # |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 0101036326 (Virginia) | Primary |
| Provider Name | Samir Nazam |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1578684841 PECOS PAC ID: 0143377374 Enrollment ID: I20090406000117 |
| Provider Name | Tracy Bishop Devany |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649258849 PECOS PAC ID: 4183721574 Enrollment ID: I20120402000301 |
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