Provider Demographics
NPI:1225064082
Name:VIRGINIA MED CENTER PC
Entity Type:Organization
Organization Name:VIRGINIA MED CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:IRFAN
Authorized Official - Middle Name:
Authorized Official - Last Name:IDREES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-338-0032
Mailing Address - Street 1:609 E MAIN ST
Mailing Address - Street 2:STE Q
Mailing Address - City:PURCELLVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20132-3182
Mailing Address - Country:US
Mailing Address - Phone:540-338-0032
Mailing Address - Fax:540-338-0176
Practice Address - Street 1:609 E MAIN ST
Practice Address - Street 2:STE Q
Practice Address - City:PURCELLVILLE
Practice Address - State:VA
Practice Address - Zip Code:20132-3182
Practice Address - Country:US
Practice Address - Phone:540-338-0032
Practice Address - Fax:540-338-0176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-24
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101233733207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DF5474OtherMEDICARE RAILROAD
VA196545OtherANTHEM BC
DC7286OtherBC OF WASH DC
VA196545OtherANTHEM BC