Healthcare Provider Details

I. General information

NPI: 1740560135
Provider Name (Legal Business Name): QUANTUMBARIATRICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2011
Last Update Date: 08/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11335 SUNSET HILLS RD
RESTON VA
20190-5205
US

IV. Provider business mailing address

PO BOX 1048
GREAT FALLS VA
22066
US

V. Phone/Fax

Practice location:
  • Phone: 703-639-5529
  • Fax:
Mailing address:
  • Phone: 703-639-5529
  • Fax: 703-444-4308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. PANKAJ MERCHIA
Title or Position: MANAGER
Credential: M.D.
Phone: 703-639-5529