| None | |
|
106 Elden St Suite 10 Herndon VA 20170-4872 | |
| (703) 481-3131 | |
| (703) 471-1173 |
| Full Name | None |
|---|---|
| Speciality | Family Medicine - Adult Medicine |
| Location | 106 Elden St, Herndon, Virginia |
| Authorized Official Name and Position | Charles Payling-wright (SECRETARY) |
| Authorized Official Contact | 7034813131 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| None 106 Elden St Suite 10 Herndon VA 20170-4872 Ph: (703) 481-3131 | None 106 Elden St Suite 10 Herndon VA 20170-4872 Ph: (703) 481-3131 |
| NPI Number | 1699895508 |
|---|---|
| Provider Enumeration Date | 04/02/2007 |
| Last Update Date | 01/02/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699895508 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QA0505X | Family Medicine - Adult Medicine | (* (Not Available)) | Primary |
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