Provider Demographics
NPI:1417150665
Name:PIEDMONT MEDICAL CLINIC
Entity Type:Organization
Organization Name:PIEDMONT MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:D.O
Authorized Official - Prefix:MRS
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:S
Authorized Official - Last Name:FLORES
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:703-393-8883
Mailing Address - Street 1:7960 DONEGAN DR
Mailing Address - Street 2:SUITE 217
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20109-8236
Mailing Address - Country:US
Mailing Address - Phone:703-393-8883
Mailing Address - Fax:703-393-8857
Practice Address - Street 1:7960 DONEGAN DR
Practice Address - Street 2:SUITE 217
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20109-8236
Practice Address - Country:US
Practice Address - Phone:703-393-8883
Practice Address - Fax:703-393-8857
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes170100000XOther Service ProvidersMedical Genetics, Ph.D. Medical GeneticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA26738Medicare UPIN