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General NPI Number Information
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NPI Number | 1710204425
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Entity Type | Organization
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Legal Business Name | VIRGINIA MEDICAL SERVICES LLC
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Dates
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Enumeration Date | 04/21/2010
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Last Update Date | 04/21/2010
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Provider Practice Location Address
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Address Line | 3534 CARLIN SPRINGS RD STE 6
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City | FALLS CHURCH
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State | VA
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Zip | 22041-3095
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Country | US
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Telephone | 703-436-1626
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Fax | 703-635-3299
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Provider Business Mailing Address
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Address Line | 3534 CARLIN SPRINGS RD STE 6
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City | FALLS CHURCH
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State | VA
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Zip | 22041-3095
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Country | US
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Telephone | 703-436-1626
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Fax | 703-635-3299
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Authorized Official
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Title or Position | MANAGER
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Name | MR. SEIFU TESHOME SERTSE
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Credential | MT(ASCP)
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Telephone | 703-436-1626
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | MT-202857
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License Number State | VA
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