1497936017 NPI number — QUALITY INTERNAL MEDICINE, PLLC

Table of content: (NPI 1497936017)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497936017 NPI number — QUALITY INTERNAL MEDICINE, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
QUALITY INTERNAL MEDICINE, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1497936017
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/28/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1860 TOWN CENTER DRIVE
Provider Second Line Business Mailing Address:
SUITE 255
Provider Business Mailing Address City Name:
RESTON
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
20190-5906
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-707-0607
Provider Business Mailing Address Fax Number:
703-707-0949

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1860 TOWN CENTER DRIVE
Provider Second Line Business Practice Location Address:
SUITE 255
Provider Business Practice Location Address City Name:
RESTON
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
20190-5906
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-707-0607
Provider Business Practice Location Address Fax Number:
703-707-0949
Provider Enumeration Date:
11/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
EAPEN
Authorized Official First Name:
ANNE ROSE
Authorized Official Middle Name:
NAVARRO
Authorized Official Title or Position:
PHYSICIAN-OWNER
Authorized Official Telephone Number:
703-855-1119

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  101045101 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 570451 . This is a "CIGNA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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