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General NPI Number Information
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NPI Number | 1861616310
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Entity Type | Organization
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Legal Business Name | ANNANDALE MEDICAL ASSOCIATES PC
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Dates
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Enumeration Date | 04/13/2007
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Last Update Date | 02/28/2012
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Provider Practice Location Address
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Address Line | 4229 LAFAYETTE CENTER DRIVE SUITE #1790
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City | CHANTILLY
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State | VA
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Zip | 20151-1267
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Country | US
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Telephone | 703-378-3508
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Fax | 703-378-6414
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Provider Business Mailing Address
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Address Line | PO BOX 9302
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City | MC LEAN
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State | VA
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Zip | 22102-0302
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Country | US
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Telephone | 703-378-3508
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Fax | 703-378-6414
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Authorized Official
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Title or Position | MD
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Name | MRS. INGRID INSOOK CHUNG
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Credential | M.D.
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Telephone | 703-378-3508
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 0101049525
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License Number State | VA
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