Healthcare Provider Details

I. General information

NPI: 1336416486
Provider Name (Legal Business Name): LYNC HEALTH PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2011
Last Update Date: 11/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 S CARLIN SPRINGS RD SUITE 301
ARLINGTON VA
22204-1064
US

IV. Provider business mailing address

6625 MADISON MCLEAN DR
MC LEAN VA
22101-2902
US

V. Phone/Fax

Practice location:
  • Phone: 703-998-0480
  • Fax:
Mailing address:
  • Phone: 703-395-0491
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101244402
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number0101244402
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number0101244402
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number0101244402
License Number StateVA

VIII. Authorized Official

Name: DR. LATHA NACHIMUTHU
Title or Position: DIRECTOR
Credential: MD
Phone: 703-395-0491