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General NPI Number Information
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NPI Number | 1780079558
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Entity Type | Organization
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Legal Business Name | MEDICAL AVENUE INTERNAL MEDICINE PC
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Dates
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Enumeration Date | 03/30/2015
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Last Update Date | 04/20/2015
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Provider Practice Location Address
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Address Line | 1920 MEDICAL AVE STE F
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City | HARRISONBURG
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State | VA
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Zip | 22801-8016
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Country | US
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Telephone | 540-908-3095
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Fax | 540-908-3085
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Provider Business Mailing Address
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Address Line | 1920 MEDICAL AVE STE F
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City | HARRISONBURG
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State | VA
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Zip | 22801-8016
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Country | US
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Telephone | 540-908-3095
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Fax | 540-908-3085
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Authorized Official
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Title or Position | DIRECTOR / INCORPORATOR
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Name | DR. ILIJA STEVEN RAKARIC
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Credential |
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Telephone | 540-908-3095
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 0101054605
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License Number State | VA
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