Old Dominion Medical Center, P.c. | |
6715 Whittier Avenue Suite 100 Mclean VA 22101 | |
(703) 356-5700 | |
(703) 448-8211 |
Full Name | Old Dominion Medical Center, P.c. |
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Speciality | Family Medicine |
Location | 6715 Whittier Avenue, Mclean, Virginia |
Authorized Official Name and Position | Allen Bernard Horne (PHYSICIAN OWNER) |
Authorized Official Contact | 7033565700 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Old Dominion Medical Center, P.c. 6715 Whittier Avenue Suite 100 Mclean VA 22101 Ph: (703) 356-5700 | Old Dominion Medical Center, P.c. 6715 Whittier Avenue Suite 100 Mclean VA 22101 Ph: (703) 356-5700 |
NPI Number | 1104990167 |
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Provider Enumeration Date | 11/20/2006 |
Last Update Date | 02/04/2016 |
Medicare PECOS PAC ID | 3971545583 |
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Medicare Enrollment ID | O20050524001004 |
Identifier | Type | State | Issuer |
---|---|---|---|
1104990167 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207Q00000X | Family Medicine | (* (Not Available)) | Primary |
Provider Name | Allen Horne |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1225178296 PECOS PAC ID: 2163695008 Enrollment ID: I20120313000027 |
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