| Great Falls Geriatric Medicine, Llc | |
|
10017 Park Royal Dr Great Falls VA 22066-1847 | |
| (703) 947-7377 | |
| Not Available |
| Full Name | Great Falls Geriatric Medicine, Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 10017 Park Royal Dr, Great Falls, Virginia |
| Authorized Official Name and Position | Carol Reyburn Martin (PHYSICIAN) |
| Authorized Official Contact | 7039477377 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Great Falls Geriatric Medicine, Llc Po Box 440 Great Falls VA 22066-0440 Ph: () - | Great Falls Geriatric Medicine, Llc 10017 Park Royal Dr Great Falls VA 22066-1847 Ph: (703) 947-7377 |
| NPI Number | 1164019162 |
|---|---|
| Provider Enumeration Date | 12/23/2020 |
| Last Update Date | 12/23/2020 |
| Medicare PECOS PAC ID | 9032522339 |
|---|---|
| Medicare Enrollment ID | O20210105003236 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164019162 | NPI | - | NPPES |
| 0101265405 | Other | VA | MEDICAL LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0300X | Internal Medicine - Geriatric Medicine | (* (Not Available)) | Primary |
| Provider Name | Carol R Martin |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1134347347 PECOS PAC ID: 4486830908 Enrollment ID: I20190103002962 |
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