| Trident Medical Group Llc | |
|
19415 Deerfield Ave Ste 103 Lansdowne VA 20176-8470 | |
| (703) 509-9198 | |
| Not Available |
| Full Name | Trident Medical Group Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 19415 Deerfield Ave Ste 103, Lansdowne, Virginia |
| Authorized Official Name and Position | Naresh Bassi (PRESIDENT) |
| Authorized Official Contact | 7035099198 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Trident Medical Group Llc 42115 Pemberly Ct Chantilly VA 20152-5982 Ph: (703) 509-9198 | Trident Medical Group Llc 19415 Deerfield Ave Ste 103 Lansdowne VA 20176-8470 Ph: (703) 509-9198 |
| NPI Number | 1043984115 |
|---|---|
| Provider Enumeration Date | 08/03/2021 |
| Last Update Date | 04/05/2022 |
| Medicare PECOS PAC ID | 1153729595 |
|---|---|
| Medicare Enrollment ID | O20211014002928 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043984115 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Naresh Bassi |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1801076419 PECOS PAC ID: 5294927380 Enrollment ID: I20110420000835 |
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