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General NPI Number Information
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NPI Number | 1962893974
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Entity Type | Organization
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Legal Business Name | FAMILY IMMEDIATE CARE,LLC
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Dates
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Enumeration Date | 02/12/2015
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Last Update Date | 02/12/2015
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Provider Practice Location Address
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Address Line | 420 ELDEN ST
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City | HERNDON
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State | VA
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Zip | 20170-4511
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Country | US
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Telephone | 571-218-5788
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Fax |
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Provider Business Mailing Address
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Address Line | 9429 WINTERSET DR
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City | POTOMAC
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State | MD
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Zip | 20854-2845
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Country | US
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Telephone | 571-218-5788
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. PHETPAILIN AMARALIKIT
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Credential | M.D.
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Telephone | 571-218-5788
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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 | 0101244099
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License Number State | VA
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