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General NPI Number Information
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NPI Number | 1225457591
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Entity Type | Organization
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Legal Business Name | CARE MEDICAL LLC
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Dates
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Enumeration Date | 04/15/2014
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Last Update Date | 04/15/2014
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Provider Practice Location Address
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Address Line | 25303 GOTHIC SQ
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City | CHANTILLY
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State | VA
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Zip | 20152-4104
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Country | US
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Telephone | 703-396-5292
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Fax | 703-396-5297
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Provider Business Mailing Address
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Address Line | 25303 GOTHIC SQ
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City | CHANTILLY
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State | VA
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Zip | 20152-4104
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Country | US
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Telephone | 703-396-5292
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Fax | 703-396-5297
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Authorized Official
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Title or Position | OWNER
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Name | NIRAV K THAKKAR
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Credential | M.D.
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Telephone | 502-212-9393
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 0101252586
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License Number State | VA
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