Healthcare Provider Details

I. General information

NPI: 1225457591
Provider Name (Legal Business Name): CARE MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2014
Last Update Date: 04/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25303 GOTHIC SQ
CHANTILLY VA
20152-4104
US

IV. Provider business mailing address

25303 GOTHIC SQ
CHANTILLY VA
20152-4104
US

V. Phone/Fax

Practice location:
  • Phone: 703-396-5292
  • Fax: 703-396-5297
Mailing address:
  • Phone: 703-396-5292
  • Fax: 703-396-5297

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101252586
License Number StateVA

VIII. Authorized Official

Name: NIRAV K THAKKAR
Title or Position: OWNER
Credential: M.D.
Phone: 502-212-9393