Healthcare Provider Details

I. General information

NPI: 1740878420
Provider Name (Legal Business Name): PERSONIC VIRTUAL CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2021
Last Update Date: 02/26/2024
Certification Date: 02/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10320 LITTLE PATUXENT PKWY STE 200
COLUMBIA MD
21044-3344
US

IV. Provider business mailing address

8133 LEESBURG PIKE STE 630
VIENNA VA
22182-2730
US

V. Phone/Fax

Practice location:
  • Phone: 251-901-3011
  • Fax: 215-933-6837
Mailing address:
  • Phone: 251-901-3011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: SYED NAQVI
Title or Position: DO
Credential:
Phone: 251-901-3011