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General NPI Number Information
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NPI Number | 1376917070
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Entity Type | Organization
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Legal Business Name | EMERGENCY MEDICINE ASSOCIATES, P.A.,P.C.
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Dates
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Enumeration Date | 11/18/2015
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Last Update Date | 12/17/2024
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Provider Practice Location Address
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Address Line | 24440 STONE SPRINGS BOULEVARD
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City | DULLES
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State | VA
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Zip | 20166
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Country | US
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Telephone | 202-574-6000
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Fax | 202-373-3739
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Provider Business Mailing Address
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Address Line | 20010 CENTURY BLVD STE 200
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City | GERMANTOWN
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State | MD
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Zip | 20874-1118
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Country | US
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Telephone | 240-686-2320
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Fax |
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Authorized Official
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Title or Position | PROVIDER ENROLLMENT
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Name | JENNIFER CHASTAIN
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Credential |
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Telephone | 330-493-4443
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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 |
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License Number State | VA
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