Healthcare Provider Details

I. General information

NPI: 1245298744
Provider Name (Legal Business Name): PROGRESSIVE MEDICAL ASSOCIATES, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 12/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2841 HARTLAND RD STE 405
FALLS CHURCH VA
22043-3500
US

IV. Provider business mailing address

2841 HARTLAND RD STE 405
FALLS CHURCH VA
22043-3500
US

V. Phone/Fax

Practice location:
  • Phone: 703-876-6131
  • Fax: 703-876-6009
Mailing address:
  • Phone: 703-876-6131
  • Fax: 703-876-6009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number0101034067
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number0101227771
License Number StateVA

VIII. Authorized Official

Name: NAMRATA PRASAD
Title or Position: OFFICE ADMINISTRATOR
Credential:
Phone: 703-876-6131