| Lake Ridge Internal Medicne, Pc | |
|
1725 Financial Loop Woodbridge VA 22192-2460 | |
| (703) 492-1108 | |
| Not Available |
| Full Name | Lake Ridge Internal Medicne, Pc |
|---|---|
| Speciality | Internal Medicine |
| Location | 1725 Financial Loop, Woodbridge, Virginia |
| Authorized Official Name and Position | Bassam Farah (PRESIDENT) |
| Authorized Official Contact | 7034921108 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lake Ridge Internal Medicne, Pc 1725 Financial Loop Woodbridge VA 22192-2460 Ph: (703) 492-1108 | Lake Ridge Internal Medicne, Pc 1725 Financial Loop Woodbridge VA 22192-2460 Ph: (703) 492-1108 |
| NPI Number | 1316163256 |
|---|---|
| Provider Enumeration Date | 04/18/2007 |
| Last Update Date | 04/16/2012 |
| Medicare PECOS PAC ID | 2668445461 |
|---|---|
| Medicare Enrollment ID | O20040819000156 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316163256 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Bassam Farah |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1295848497 PECOS PAC ID: 3274506076 Enrollment ID: I20040819000174 |
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