Provider Demographics
NPI:1083839211
Name:PRIMARY CARE DOCTORS GROUP,PC
Entity Type:Organization
Organization Name:PRIMARY CARE DOCTORS GROUP,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BEJJENKI
Authorized Official - Middle Name:S
Authorized Official - Last Name:CHARY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:202-291-3122
Mailing Address - Street 1:2616 SHERWOOD HALL LN
Mailing Address - Street 2:SUITE 303
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22306-3100
Mailing Address - Country:US
Mailing Address - Phone:703-799-1118
Mailing Address - Fax:703-799-1586
Practice Address - Street 1:2616 SHERWOOD HALL LN
Practice Address - Street 2:SUITE 303
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22306-3100
Practice Address - Country:US
Practice Address - Phone:703-799-1118
Practice Address - Fax:703-799-1586
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-14
Last Update Date:2011-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC023831200Medicaid
VAG00993Medicare ID - Type Unspecified