Healthcare Provider Details

I. General information

NPI: 1104407204
Provider Name (Legal Business Name): ATLANTIC INTEGRATIVE MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2021
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 PIDGEON HILL DR STE 210
STERLING VA
20165-6129
US

IV. Provider business mailing address

2 PIDGEON HILL DR STE 210
STERLING VA
20165-6129
US

V. Phone/Fax

Practice location:
  • Phone: 703-376-1284
  • Fax:
Mailing address:
  • Phone: 703-376-1284
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JONATHAN D CLAAR
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 540-442-8555