Healthcare Provider Details

I. General information

NPI: 1851530109
Provider Name (Legal Business Name): SLEEPHEART FACILITIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2009
Last Update Date: 02/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 TOWN CENTER PKWY PAVILION BUILDING, SUITE 303
RESTON VA
20190-3219
US

IV. Provider business mailing address

1147 MEADOWLOOK CT
RESTON VA
20194-1438
US

V. Phone/Fax

Practice location:
  • Phone: 703-348-7857
  • Fax:
Mailing address:
  • Phone: 617-401-8929
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. PANKAJ MERCHIA
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 703-348-7857