| Medical Clinic Of Woodbridge Inc | |
|
12716 Directors Loop Woodbridge VA 22192 | |
| (703) 497-1964 | |
| (703) 497-9885 |
| Full Name | Medical Clinic Of Woodbridge Inc |
|---|---|
| Speciality | Internal Medicine |
| Location | 12716 Directors Loop, Woodbridge, Virginia |
| Authorized Official Name and Position | Gabriel Obiorah Nwufoh (PRESIDENT) |
| Authorized Official Contact | 7034971964 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Medical Clinic Of Woodbridge Inc 1690 Old Bridge Rd Ste 200 Woodbridge VA 22192-8006 Ph: (703) 497-1964 | Medical Clinic Of Woodbridge Inc 12716 Directors Loop Woodbridge VA 22192 Ph: (703) 497-1964 |
| NPI Number | 1336334275 |
|---|---|
| Provider Enumeration Date | 09/13/2007 |
| Last Update Date | 09/26/2024 |
| Medicare PECOS PAC ID | 1254506736 |
|---|---|
| Medicare Enrollment ID | O20111212000603 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336334275 | NPI | - | NPPES |
| 005821037 | Medicaid | VA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 0101057783 (* (Not Available)) | Primary |
| Provider Name | Gabriel Obiorah Nwufoh |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1396759692 PECOS PAC ID: 2163697640 Enrollment ID: I20111212000622 |
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