Healthcare Provider Details

I. General information

NPI: 1508953167
Provider Name (Legal Business Name): ANNANDALE FAMILY MEDICINE, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7617 LITTLE RIVER TPKE SUITE 710
ANNANDALE VA
22003-2603
US

IV. Provider business mailing address

7617 LITTLE RIVER TPKE SUITE 710
ANNANDALE VA
22003-2603
US

V. Phone/Fax

Practice location:
  • Phone: 703-941-0267
  • Fax: 703-941-2018
Mailing address:
  • Phone: 703-941-0267
  • Fax: 703-941-2018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. RHONDA L FRIEDLER
Title or Position: ADMINISTRATOR
Credential:
Phone: 703-941-0267