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General NPI Number Information
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NPI Number | 1316560873
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Entity Type | Organization
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Legal Business Name | FRONTIER INTEGRATIVE MEDICINE LLC
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Dates
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Enumeration Date | 05/19/2020
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Last Update Date | 05/19/2020
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Provider Practice Location Address
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Address Line | 42502 OXFORD FOREST CIR
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City | CHANTILLY
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State | VA
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Zip | 20152-5970
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Country | US
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Telephone | 703-957-8974
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Fax |
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Provider Business Mailing Address
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Address Line | 42502 OXFORD FOREST CIR
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City | CHANTILLY
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State | VA
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Zip | 20152-5970
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Country | US
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Telephone | 703-957-8974
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Fax |
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Authorized Official
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Title or Position | FNP
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Name | SALIL MALHOTRA
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Credential | MSN, DC
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Telephone | 703-957-8974
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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