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General NPI Number Information
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NPI Number | 1356601058
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Entity Type | Organization
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Legal Business Name | INTERNAL MEDICINE GROUP LLC
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Dates
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Enumeration Date | 05/29/2012
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Last Update Date | 05/29/2012
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Provider Practice Location Address
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Address Line | 3301 WOODBURN RD SUITE 304
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City | ANNANDALE
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State | VA
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Zip | 22003-1229
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Country | US
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Telephone | 703-204-0355
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Fax | 703-204-0356
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Provider Business Mailing Address
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Address Line | 4034 CAIRO PL
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City | WOODBRIDGE
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State | VA
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Zip | 22192-7616
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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 | DIRECTOR
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Name | DR. TAHIR SHAIKH
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Credential | DO, MBBS
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Telephone | 703-204-0355
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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 | 0102202240
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License Number State | VA
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