Healthcare Provider Details

I. General information

NPI: 1992312029
Provider Name (Legal Business Name): VITAL CARE ENDOCRINOLOGY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2020
Last Update Date: 01/05/2021
Certification Date: 01/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1830 TOWN CENTER DR STE 306
RESTON VA
20190-3217
US

IV. Provider business mailing address

1830 TOWN CENTER DR STE 306
RESTON VA
20190-3217
US

V. Phone/Fax

Practice location:
  • Phone: 571-450-8300
  • Fax: 571-450-8301
Mailing address:
  • Phone: 571-450-8300
  • Fax: 571-450-8301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: NEEHARIKA REPAKA
Title or Position: OWNER
Credential: MD
Phone: 540-889-0199