Healthcare Provider Details

I. General information

NPI: 1356460331
Provider Name (Legal Business Name): INTEGRATED MEDICAL CARE AND REHAB.,PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 04/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 KING STREET SUITE 4R
ALEXANDRIA VA
22302
US

IV. Provider business mailing address

PO BOX 11529
ALEXANDRIA VA
22312-0529
US

V. Phone/Fax

Practice location:
  • Phone: 703-820-8050
  • Fax: 703-820-8720
Mailing address:
  • Phone: 703-820-8050
  • Fax: 703-820-8720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number0101223994
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number0101223994
License Number StateVA

VIII. Authorized Official

Name: DR. ABRAHAM YIMER ASMAMAW
Title or Position: PRESIDENT
Credential: M.D.
Phone: 703-820-8050