Healthcare Provider Details

I. General information

NPI: 1700680444
Provider Name (Legal Business Name): AMERICARE NUCMED CLINIC & GENERAL PRACTICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2025
Last Update Date: 04/21/2025
Certification Date: 04/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 WOODBURN RD STE 102
ANNANDALE VA
22003-6889
US

IV. Provider business mailing address

3301 WOODBURN RD STE 102
ANNANDALE VA
22003-6889
US

V. Phone/Fax

Practice location:
  • Phone: 703-894-0009
  • Fax:
Mailing address:
  • Phone: 703-894-0009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2085N0904X
TaxonomyNuclear Radiology Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: NANA VINCENT
Title or Position: MANAGER
Credential:
Phone: 240-424-9615