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General NPI Number Information
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NPI Number | 1972538817
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Entity Type | Organization
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Legal Business Name | INTERNAL MEDICINE OF STAFFORD
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Dates
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Enumeration Date | 07/11/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 422 GARRISONVILLE RD SUITE 108
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City | STAFFORD
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State | VA
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Zip | 22554-1573
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Country | US
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Telephone | 540-658-9340
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Fax | 540-658-9344
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Provider Business Mailing Address
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Address Line | 422 GARRISONVILLE RD SUITE 108
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City | STAFFORD
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State | VA
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Zip | 22554-1573
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Country | US
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Telephone | 540-658-9340
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Fax | 540-658-9344
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Authorized Official
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Title or Position | PHYSICIAN/OWNER
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Name | NIBEDITA MOHANTY
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Credential | M.D.
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Telephone | 540-658-9340
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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 | 0101045978
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License Number State | VA
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