Provider Demographics
NPI:1407939549
Name:MCLEAN CENTER FOR COMPLEMENTARY AND ALTERNATIVE MEDICINE, PLC
Entity Type:Organization
Organization Name:MCLEAN CENTER FOR COMPLEMENTARY AND ALTERNATIVE MEDICINE, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:Y
Authorized Official - Last Name:FAN
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:703-499-4428
Mailing Address - Street 1:8214 OLD COURTHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3885
Mailing Address - Country:US
Mailing Address - Phone:703-499-4428
Mailing Address - Fax:703-547-8197
Practice Address - Street 1:8214 OLD COURTHOUSE RD
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-3885
Practice Address - Country:US
Practice Address - Phone:703-499-4428
Practice Address - Fax:703-547-8197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0121000278171100000X
DCAC30091171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAJ3980001OtherCAREFIRST BCBS PROVIDERID