Provider Demographics
NPI:1356460331
Name:INTEGRATED MEDICAL CARE AND REHAB.,PC
Entity Type:Organization
Organization Name:INTEGRATED MEDICAL CARE AND REHAB.,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ABRAHAM
Authorized Official - Middle Name:YIMER
Authorized Official - Last Name:ASMAMAW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-820-8050
Mailing Address - Street 1:PO BOX 11529
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22312-0529
Mailing Address - Country:US
Mailing Address - Phone:703-820-8050
Mailing Address - Fax:703-820-8720
Practice Address - Street 1:4600 KING STREET
Practice Address - Street 2:SUITE 4R
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22302
Practice Address - Country:US
Practice Address - Phone:703-820-8050
Practice Address - Fax:703-820-8720
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101223994208100000X, 2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC08846Medicare PIN
VAG93995Medicare UPIN
DCG00992Medicare PIN