Provider Demographics
NPI:1073842282
Name:LOUDOUN WALK IN MEDICAL CENTER, LLC
Entity Type:Organization
Organization Name:LOUDOUN WALK IN MEDICAL CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:FUAD
Authorized Official - Middle Name:
Authorized Official - Last Name:ALYKHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-726-9056
Mailing Address - Street 1:44320 PREMIER PLZ
Mailing Address - Street 2:SUITE 120
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-5076
Mailing Address - Country:US
Mailing Address - Phone:703-726-9056
Mailing Address - Fax:703-726-9058
Practice Address - Street 1:44320 PREMIER PLZ
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-5076
Practice Address - Country:US
Practice Address - Phone:703-726-9056
Practice Address - Fax:703-726-9058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-17
Last Update Date:2009-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101059077261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center