Provider Demographics
NPI:1124388830
Name:ASCLEPEION PRIMARY CARE, INC
Entity Type:Organization
Organization Name:ASCLEPEION PRIMARY CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MONSURUL
Authorized Official - Middle Name:H
Authorized Official - Last Name:KHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-720-5500
Mailing Address - Street 1:180 QUEEN ANNE DR
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22406-4653
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:556 GARRISONVILLE RD
Practice Address - Street 2:SUITE 204
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-7826
Practice Address - Country:US
Practice Address - Phone:540-720-5500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-29
Last Update Date:2012-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
H50095Medicare UPIN