Healthcare Provider Details

I. General information

NPI: 1982383600
Provider Name (Legal Business Name): INFUSIUM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2023
Last Update Date: 07/12/2023
Certification Date: 07/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 CEDAR CREEK GRADE STE 200
WINCHESTER VA
22601-7100
US

IV. Provider business mailing address

905 CEDAR CREEK GRADE STE 200
WINCHESTER VA
22601-7100
US

V. Phone/Fax

Practice location:
  • Phone: 540-722-8882
  • Fax: 540-722-8883
Mailing address:
  • Phone: 540-722-8882
  • Fax: 540-722-8883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARK A LANDRIO
Title or Position: DR
Credential: MD
Phone: 540-539-6564