Basic Information
| Provider Information | |||||||||
| NPI: | 1134485246 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VIRGINIA HOSPITAL CENTER PHYSICIAN GROUP LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | VIRGINIA HOSPITAL CENTER PHYSICIAN GROUP PRIMARY CARE - ALEXANDRIA | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1715 N GEORGE MASON DR | ||||||||
| Address2: | SUITE 409 | ||||||||
| City: | ARLINGTON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 222053609 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7037174148 | ||||||||
| FaxNumber: | 7037174149 | ||||||||
| Practice Location | |||||||||
| Address1: | 1600 N BEAUREGARD ST | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | ALEXANDRIA | ||||||||
| State: | VA | ||||||||
| PostalCode: | 223111704 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7037174148 | ||||||||
| FaxNumber: | 7037174149 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/03/2012 | ||||||||
| LastUpdateDate: | 12/31/2015 | ||||||||
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| AuthorizedOfficialLastName: | DEPAOLI | ||||||||
| AuthorizedOfficialFirstName: | ROBIN | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 7035586104 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | 207R00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.