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General NPI Number Information
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NPI Number | 1073842282
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Entity Type | Organization
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Legal Business Name | LOUDOUN WALK IN MEDICAL CENTER, LLC
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Dates
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Enumeration Date | 12/17/2009
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Last Update Date | 12/18/2009
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Provider Practice Location Address
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Address Line | 44320 PREMIER PLZ
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City | ASHBURN
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State | VA
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Zip | 20147-5076
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Country | US
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Telephone | 703-726-9056
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Fax | 703-726-9058
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Provider Business Mailing Address
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Address Line | 44320 PREMIER PLZ SUITE 120
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City | ASHBURN
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State | VA
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Zip | 20147-5076
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Country | US
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Telephone | 703-726-9056
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Fax | 703-726-9058
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Authorized Official
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Title or Position | CEO
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Name | DR. FUAD ALYKHAN
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Credential | M.D.
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Telephone | 703-726-9056
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 0101059077
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License Number State | VA
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