Healthcare Provider Details

I. General information

NPI: 1154561389
Provider Name (Legal Business Name): ALTMED MEDICAL CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2009
Last Update Date: 05/20/2024
Certification Date: 05/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8551 RIXLEW LANE SUITE 140
MANASSAS VA
20109-4278
US

IV. Provider business mailing address

P.O. BOX 2041
MANASSAS VA
20108-0815
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 TaxonomyY
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberD0054211
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: GERALD K LEE
Title or Position: MEDICAL DIRECTOR
Credential: M.D., PHD.
Phone: 703-361-4357