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General NPI Number Information
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NPI Number | 1376062836
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Entity Type | Organization
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Legal Business Name | VIRGINIA INTEGRATIVE PRACTICE
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Dates
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Enumeration Date | 09/15/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 8996 BURKE LAKE RD STE 303
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City | BURKE
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State | VA
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Zip | 22015-1607
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Country | US
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Telephone | 888-299-4570
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Fax | 888-398-0897
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Provider Business Mailing Address
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Address Line | 8996 BURKE LAKE RD STE 303
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City | BURKE
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State | VA
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Zip | 22015-1607
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Country | US
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Telephone | 888-299-4570
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Fax | 888-398-0897
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | VAJRA JAI
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Credential |
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Telephone | 888-299-4570
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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 | 0101242686
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 0101244564
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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