Healthcare Provider Details

I. General information

NPI: 1922345313
Provider Name (Legal Business Name): WITHINME MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2013
Last Update Date: 01/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5275 LEE HWY STE 101
ARLINGTON VA
22207-1619
US

IV. Provider business mailing address

5275 LEE HWY STE 101
ARLINGTON VA
22207-1619
US

V. Phone/Fax

Practice location:
  • Phone: 804-441-5040
  • Fax:
Mailing address:
  • Phone: 804-441-5040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number0101232169
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code261QC1800X
TaxonomyCorporate Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. DERRON SIMON
Title or Position: CHIEF MEDICAL DIRECTOR
Credential: M.D.
Phone: 703-430-1411