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General NPI Number Information
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NPI Number | 1669403051
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Entity Type | Organization
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Legal Business Name | INTERNAL MEDICINE PRACTICE ASSOCIATES PC
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Dates
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Enumeration Date | 07/05/2006
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Last Update Date | 10/31/2011
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Provider Practice Location Address
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Address Line | 46090 LAKE CENTER PLZ 201
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City | POTOMAC FALLS
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State | VA
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Zip | 20165-5876
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Country | US
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Telephone | 703-444-6544
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Fax | 703-444-1121
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Provider Business Mailing Address
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Address Line | 46090 LAKE CENTER PLZ 201
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City | POTOMAC FALLS
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State | VA
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Zip | 20165-5876
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Country | US
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Telephone | 703-444-6544
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Fax | 703-444-1121
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. ALOK RUSTOGI
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Credential | MD
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Telephone | 703-880-5539
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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 | 0101236706
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License Number State | VA
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