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General NPI Number Information
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NPI Number | 1861228660
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Entity Type | Organization
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Legal Business Name | ALTMED MEDICAL SERVICES LLC
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Dates
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Enumeration Date | 09/10/2024
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Last Update Date | 09/10/2024
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Provider Practice Location Address
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Address Line | 8551 RIXLEW LN STE 140
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City | MANASSAS
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State | VA
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Zip | 20109-4278
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Country | US
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Telephone | 703-361-4357
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Fax | 703-361-0346
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Provider Business Mailing Address
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Address Line | 8551 RIXLEW LN STE 140
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City | MANASSAS
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State | VA
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Zip | 20109-4278
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Country | US
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Telephone | 703-361-4357
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Fax | 703-361-0346
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Authorized Official
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Title or Position | MANAGER
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Name | MADHUSUDAN PANTHI
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Credential |
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Telephone | 703-485-2000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207QA0401X
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Taxonomy Name | Addiction Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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