MEDICARE: CLARENDON CLINIC, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	0101034371	VA

General Provider Information

NPI Number	:	1932296159
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLARENDON CLINIC, PC

Provider Business Mailing Address
First Line	:	1220 N HUDSON ST
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22201-5048
Country	:	US
Telephone Number	:	703-243-0250
Fax Number	:	703-243-0148

Provider Business Practice Location Address
First Line	:	1220 N HUDSON ST
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22201-5048
Country	:	US
Telephone Number	:	703-243-0250
Fax Number	:	703-243-0148

Authorized Official
Title or Position	:	MEDICAL OFFICER
Name	:	PHUOC KIM DOAN
Credential	:	MD
Telephone Number	:	703-243-0250

Provider Enumeration Date	:	10/09/2006
Last Update Date	:	08/22/2020

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