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General NPI Number Information
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NPI Number | 1114018249
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Entity Type | Organization
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Legal Business Name | BRISTOW RUN FAMILY PRACTICE, PC
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Dates
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Enumeration Date | 09/27/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 14540 JOHN MARSHALL HWY SUITE 104
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City | GAINESVILLE
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State | VA
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Zip | 20155-1691
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Country | US
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Telephone | 703-753-9799
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Fax | 703-753-9792
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Provider Business Mailing Address
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Address Line | 14540 JOHN MARSHALL HWY SUITE 104
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City | GAINESVILLE
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State | VA
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Zip | 20155-1691
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Country | US
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Telephone | 703-753-9799
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Fax | 703-753-9792
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. STEVEN J TANG
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Credential | M.D.
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Telephone | 703-753-9799
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 0101230910
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License Number State | VA
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