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General NPI Number Information
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NPI Number | 1477885341
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Entity Type | Organization
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Legal Business Name | THE MEDICAL CLINIC
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Dates
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Enumeration Date | 02/03/2010
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Last Update Date | 04/05/2010
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Provider Practice Location Address
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Address Line | 4217 EVERGREEN LN
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City | ANNANDALE
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State | VA
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Zip | 22003-3210
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Country | US
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Telephone | 301-886-8363
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Fax | 301-441-8806
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Provider Business Mailing Address
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Address Line | 12200 ANNAPOLIS RD STE 225
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City | GLENN DALE
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State | MD
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Zip | 20769-9182
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Country | US
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Telephone | 301-860-0930
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Fax | 301-809-0929
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Authorized Official
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Title or Position | PRESIDENT
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Name | SANJIV LAKHANPAL
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Credential | MD
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Telephone | 240-460-1073
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | D0053733
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License Number State | MD
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