Healthcare Provider Details

I. General information

NPI: 1790078152
Provider Name (Legal Business Name): NORMALBALANCE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2011
Last Update Date: 05/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2235 CEDAR LN STE 101
VIENNA VA
22182-5247
US

IV. Provider business mailing address

PO BOX 1048
GREAT FALLS VA
22066-9048
US

V. Phone/Fax

Practice location:
  • Phone: 703-348-7857
  • Fax:
Mailing address:
  • Phone: 301-675-0512
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RB0002X
TaxonomyObesity Medicine (Internal Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: PANKAJ MERCHIA
Title or Position: MANAGER
Credential:
Phone: 301-675-0512