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General NPI Number Information
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NPI Number | 1245598085
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Entity Type | Organization
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Legal Business Name | MEDICAL MANAGEMENT OF VIRGINIA, LLC
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Dates
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Enumeration Date | 04/30/2012
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Last Update Date | 04/30/2012
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Provider Practice Location Address
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Address Line | 11230 WAPLES MILL RD SUITE 125
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City | FAIRFAX
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State | VA
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Zip | 22030-6087
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Country | US
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Telephone | 703-246-9355
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Fax | 703-267-6977
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Provider Business Mailing Address
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Address Line | 11230 WAPLES MILL RD SUITE 125
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City | FAIRFAX
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State | VA
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Zip | 22030-6087
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Country | US
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Telephone | 703-246-9355
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Fax | 703-267-6977
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Authorized Official
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Title or Position | BUSINESS ADMINISTRATOR
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Name | JOHN BUCKNER
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Credential |
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Telephone | 703-246-9355
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State | VA
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