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General NPI Number Information
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NPI Number | 1902126949
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Entity Type | Organization
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Legal Business Name | MIDDLEBURG NEUROMUSCULAR MEDICINE AND REHABILITATION, PLC
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Dates
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Enumeration Date | 06/01/2010
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Last Update Date | 06/25/2010
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Provider Practice Location Address
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Address Line | 24430 MILLSTREAM DRIVE
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City | ALDIE
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State | VA
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Zip | 20105
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Country | US
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Telephone | 703-909-1882
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Fax |
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Provider Business Mailing Address
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Address Line | 22575 LEANNE TERRACE UNIT 426
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City | ASHBURN
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State | VA
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Zip | 20148
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Country | US
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Telephone | 703-909-1882
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Fax |
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Authorized Official
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Title or Position | OWNER/MD
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Name | DR. DOMINIQUE L VINH
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Credential | M.D.
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Telephone | 703-909-1882
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 0101047558
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License Number State | VA
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