Healthcare Provider Details

I. General information

NPI: 1861228660
Provider Name (Legal Business Name): ALTMED MEDICAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2024
Last Update Date: 09/10/2024
Certification Date: 09/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8551 RIXLEW LN STE 140
MANASSAS VA
20109-4278
US

IV. Provider business mailing address

8551 RIXLEW LN STE 140
MANASSAS VA
20109-4278
US

V. Phone/Fax

Practice location:
  • Phone: 703-361-4357
  • Fax: 703-361-0346
Mailing address:
  • Phone: 703-361-4357
  • Fax: 703-361-0346

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MADHUSUDAN PANTHI
Title or Position: MANAGER
Credential:
Phone: 703-485-2000