Provider Demographics
NPI:1376155648
Name:MOSAIC MD, PLLC
Entity Type:Organization
Organization Name:MOSAIC MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHERI
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:KOCHENDOERFER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-952-7641
Mailing Address - Street 1:22365 BRODERICK DR STE 330
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20166-9361
Mailing Address - Country:US
Mailing Address - Phone:703-952-7641
Mailing Address - Fax:703-423-0007
Practice Address - Street 1:22365 BRODERICK DR STE 330
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20166-9361
Practice Address - Country:US
Practice Address - Phone:703-952-7641
Practice Address - Fax:703-423-0007
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MOSAIC MD, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-08-18
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty