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General NPI Number Information
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NPI Number | 1891939898
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Entity Type | Organization
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Legal Business Name | FALLS CHURCH MEDICAL CARE CENTER, LLC
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Dates
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Enumeration Date | 04/22/2009
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Last Update Date | 04/22/2009
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Provider Practice Location Address
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Address Line | 3701 S GEORGE MASON DR STE C1
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City | FALLS CHURCH
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State | VA
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Zip | 22041-4722
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Country | US
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Telephone | 703-379-9202
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Fax | 703-379-9204
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Provider Business Mailing Address
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Address Line | 3701 S GEORGE MASON DR STE C1
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City | FALLS CHURCH
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State | VA
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Zip | 22041-4722
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Country | US
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Telephone | 703-379-9202
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Fax | 703-379-9204
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Authorized Official
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Title or Position | PHYSICIAN/OWNER
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Name | SAMIR NAZAM
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Credential | M.D.
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Telephone | 703-379-9202
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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 | 0101036326
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License Number State | VA
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