Provider Demographics
NPI:1073920534
Name:IMC GROUP INC
Entity Type:Organization
Organization Name:IMC GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:EUN
Authorized Official - Middle Name:H
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-642-1004
Mailing Address - Street 1:63 E MAIN ST
Mailing Address - Street 2:SUITE 6
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-5036
Mailing Address - Country:US
Mailing Address - Phone:410-848-8202
Mailing Address - Fax:410-848-2644
Practice Address - Street 1:7535 LITTLE RIVER TPKE
Practice Address - Street 2:SUITE 100C
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-2937
Practice Address - Country:US
Practice Address - Phone:703-642-1004
Practice Address - Fax:703-642-3232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-16
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty