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General NPI Number Information
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NPI Number | 1932992856
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Entity Type | Organization
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Legal Business Name | ICARE MOBILE WOUND CARE VA PLLC
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Dates
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Enumeration Date | 05/23/2025
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Last Update Date | 05/23/2025
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Provider Practice Location Address
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Address Line | 8300 BOONE BLVD
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City | VIENNA
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State | VA
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Zip | 22182-2626
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Country | US
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Telephone | 305-701-9901
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Fax |
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Provider Business Mailing Address
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Address Line | 8300 BOONE BLVD
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City | VIENNA
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State | VA
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Zip | 22182-2626
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. IVAN ISLAMAJ
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Credential | P.A.
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Telephone | 855-247-3627
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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