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General NPI Number Information
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NPI Number | 1134460876
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Entity Type | Organization
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Legal Business Name | EASY CARE URGENT CARE
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Dates
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Enumeration Date | 03/05/2013
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Last Update Date | 05/07/2013
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Provider Practice Location Address
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Address Line | 5808 MAPLEDALE PLZ
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City | WOODBRIDGE
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State | VA
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Zip | 22193-4535
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Country | US
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Telephone | 484-788-5309
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Fax |
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Provider Business Mailing Address
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Address Line | 5808 MAPLEDALE PLZ
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City | WOODBRIDGE
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State | VA
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Zip | 22193-4535
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN/OWNER
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Name | SHABANA QURESHI
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Credential | MD
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Telephone | 484-788-5309
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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 | 0101243323
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License Number State | VA
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