| North Virginia Family Practice Pc | |
|
4331 Ridgewood Center Dr Woodbridge VA 22192-5308 | |
| (703) 580-0124 | |
| (703) 580-0126 |
| Full Name | North Virginia Family Practice Pc |
|---|---|
| Speciality | Family Medicine |
| Location | 4331 Ridgewood Center Dr, Woodbridge, Virginia |
| Authorized Official Name and Position | Tejas J Shah (DIRECTOR, CEO) |
| Authorized Official Contact | 7035800124 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| North Virginia Family Practice Pc 4331 Ridgewood Center Dr Woodbridge VA 22192-5308 Ph: (703) 580-0124 | North Virginia Family Practice Pc 4331 Ridgewood Center Dr Woodbridge VA 22192-5308 Ph: (703) 580-0124 |
| NPI Number | 1417112236 |
|---|---|
| Provider Enumeration Date | 07/21/2008 |
| Last Update Date | 07/21/2008 |
| Medicare PECOS PAC ID | 0749526853 |
|---|---|
| Medicare Enrollment ID | O20190110002091 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1417112236 | NPI | - | NPPES |
| 010093139 | Medicaid | VA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 0101235482 (Virginia) | Primary |
| Provider Name | Tejas J Shah |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1881752145 PECOS PAC ID: 7012800550 Enrollment ID: I20040206000605 |
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