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General NPI Number Information
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NPI Number | 1013402593
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Entity Type | Organization
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Legal Business Name | MEDNOVATIONS LLC
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Dates
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Enumeration Date | 06/26/2018
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Last Update Date | 06/26/2018
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Provider Practice Location Address
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Address Line | 1712 FINANCIAL LOOP
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City | WOODBRIDGE
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State | VA
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Zip | 22192-2459
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Country | US
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Telephone | 571-989-4134
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Fax |
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Provider Business Mailing Address
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Address Line | 13010 SMOKETOWN RD
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City | WOODBRIDGE
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State | VA
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Zip | 22192-3367
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Country | US
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Telephone | 301-254-9444
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CHANTAL D LEWIS
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Credential | MD
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Telephone | 301-254-9444
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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