Healthcare Provider Details

I. General information

NPI: 1528792991
Provider Name (Legal Business Name): QUNIQUE MED LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2022
Last Update Date: 07/12/2022
Certification Date: 07/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

458 CRAB APPLE DR
STAFFORD VA
22554-6860
US

IV. Provider business mailing address

458 CRAB APPLE DR
STAFFORD VA
22554-6860
US

V. Phone/Fax

Practice location:
  • Phone: 540-391-1387
  • Fax:
Mailing address:
  • Phone: 540-391-1387
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: GODFRIED ASARE KENAH
Title or Position: CEO
Credential: DNP
Phone: 703-213-9005