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General NPI Number Information
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NPI Number | 1750462735
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Entity Type | Organization
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Legal Business Name | SHILOH FAMILY MEDICINE PC
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Dates
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Enumeration Date | 10/18/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5249 DUKE ST SUITE 102
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City | ALEXANDRIA
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State | VA
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Zip | 22304-2926
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Country | US
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Telephone | 703-823-3660
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Fax | 703-823-2210
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Provider Business Mailing Address
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Address Line | 5249 DUKE ST SUITE 102
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City | ALEXANDRIA
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State | VA
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Zip | 22304-2926
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Country | US
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Telephone | 703-823-3660
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Fax | 703-823-2210
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | DR. BRADLEY RICHARD WARE
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Credential | M.D.
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Telephone | 703-823-3660
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | 0101050807
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License Number State | VA
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