NPI Code Details Logo

NPI 1710856380

NPI 1710856380 : M MANAGEMENT GROUP LLC : FAIRFAX, VA

=====================================================
General NPI Number Information
=====================================================
    NPI Number           |    1710856380
-----------------------------------------------------
    Entity Type          |    Organization 
-----------------------------------------------------
    Legal Business Name  |    M MANAGEMENT GROUP LLC 
-----------------------------------------------------

=====================================================
Dates
=====================================================
    Enumeration Date     |    11/03/2025
-----------------------------------------------------
    Last Update Date     |    11/03/2025
-----------------------------------------------------

=====================================================
Provider Practice Location Address
=====================================================
    Address Line         |    10701 MAIN ST 
-----------------------------------------------------
    City                 |    FAIRFAX
-----------------------------------------------------
    State                |    VA
-----------------------------------------------------
    Zip                  |    22030-6904
-----------------------------------------------------
    Country              |    US
-----------------------------------------------------
    Telephone            |    703-273-7705
-----------------------------------------------------
    Fax                  |    
-----------------------------------------------------

=====================================================
Provider Business Mailing Address
=====================================================
    Address Line         |    6 E EAGER ST 
-----------------------------------------------------
    City                 |    BALTIMORE
-----------------------------------------------------
    State                |    MD
-----------------------------------------------------
    Zip                  |    21202-2506
-----------------------------------------------------
    Country              |    US
-----------------------------------------------------
    Telephone            |    410-870-9380
-----------------------------------------------------
    Fax                  |    410-431-3550
-----------------------------------------------------

=====================================================
Authorized Official
=====================================================
    Title or Position    |    BILLING MANAGER
-----------------------------------------------------
    Name                 |     KRYSTLE D BROWN 
-----------------------------------------------------
    Credential           |    
-----------------------------------------------------
    Telephone            |    410-800-6251
-----------------------------------------------------

=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
    Taxonomy Code        |    207R00000X
-----------------------------------------------------
    Taxonomy Name        |    Internal Medicine Physician
-----------------------------------------------------
    License Number       |    
-----------------------------------------------------
    License Number State |    
-----------------------------------------------------



                        

Copyright © 2007-2026 Data Labs Health. All rights reserved.