Provider Demographics
NPI:1003251737
Name:ASHBURN WALK-IN CLINIC & PRIMARY CARE
Entity Type:Organization
Organization Name:ASHBURN WALK-IN CLINIC & PRIMARY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VENKATESWAR
Authorized Official - Middle Name:RAO
Authorized Official - Last Name:VEERAPALLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-419-5751
Mailing Address - Street 1:21001 SYCOLIN RD
Mailing Address - Street 2:UNIT 180
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-4069
Mailing Address - Country:US
Mailing Address - Phone:540-419-5751
Mailing Address - Fax:540-727-8882
Practice Address - Street 1:21001 SYCOLIN RD
Practice Address - Street 2:UNIT 180
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-4069
Practice Address - Country:US
Practice Address - Phone:540-419-5751
Practice Address - Fax:540-727-8882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-08
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101058298305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC09687Medicare UPIN