Healthcare Provider Details

I. General information

NPI: 1437518586
Provider Name (Legal Business Name): PRIMEA HEALTH P. C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2016
Last Update Date: 03/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2616 SHERWOOD HALL LN #205
ALEXANDRIA VA
22306-3100
US

IV. Provider business mailing address

9420 FERRY LANDING CT
ALEXANDRIA VA
22309-3147
US

V. Phone/Fax

Practice location:
  • Phone: 703-501-4488
  • Fax:
Mailing address:
  • Phone: 814-241-8551
  • Fax: 703-780-0956

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number0101255410
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101255410
License Number StateVA

VIII. Authorized Official

Name: ANURADHA SOI
Title or Position: PRESIDENT
Credential:
Phone: 814-241-8551