Healthcare Provider Details

I. General information

NPI: 1750670543
Provider Name (Legal Business Name): MEDPRIME, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2011
Last Update Date: 03/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12731 MARBLESTONE DR
WOODBRIDGE VA
22192-8307
US

IV. Provider business mailing address

PO BOX 2068
WOODBRIDGE VA
22195-2068
US

V. Phone/Fax

Practice location:
  • Phone: 703-497-4700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number
License Number State

VIII. Authorized Official

Name: NAZANIN ALEMZADEH
Title or Position: MEMBER
Credential:
Phone: 703-497-4700