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General NPI Number Information
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NPI Number | 1104198001
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Entity Type | Organization
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Legal Business Name | LEESBURG MEDICAL CLINIC, PLLC
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Dates
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Enumeration Date | 02/08/2012
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Last Update Date | 06/16/2018
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Provider Practice Location Address
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Address Line | 44121 HARRY BYRD HWY STE 225
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City | ASHBURN
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State | VA
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Zip | 20147-5672
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Country | US
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Telephone | 703-596-7000
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Fax | 800-609-0775
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Provider Business Mailing Address
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Address Line | 44121 HARRY BYRD HWY STE 225
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City | ASHBURN
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State | VA
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Zip | 20147-5672
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Country | US
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Telephone | 703-596-7000
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Fax | 800-609-0775
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Authorized Official
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Title or Position | OWNER
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Name | MRS. NADYA CARRIGER
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Credential | N.P.
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Telephone | 703-596-7000
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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 | VA
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Taxonomy #2
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 0024169591
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License Number State | VA
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