Healthcare Provider Details

I. General information

NPI: 1144214222
Provider Name (Legal Business Name): INFECTIOUS DISEASES & MEDICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2005
Last Update Date: 02/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1635 N GEORGE MASON DR SUITE 180
ARLINGTON VA
22205-3601
US

IV. Provider business mailing address

1635 N GEORGE MASON DR SUITE 180
ARLINGTON VA
22205-3601
US

V. Phone/Fax

Practice location:
  • Phone: 703-276-7798
  • Fax: 703-276-0433
Mailing address:
  • Phone: 703-276-7798
  • Fax: 703-276-0433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number0101042196
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number0101038151
License Number StateVA

VIII. Authorized Official

Name: DR. M (MARGARET) ELLEN JAY
Title or Position: ADMINISTRATIVE ASSISTANT
Credential: PHD
Phone: 301-384-9008