Provider Demographics
NPI:1477885341
Name:THE MEDICAL CLINIC
Entity Type:Organization
Organization Name:THE MEDICAL CLINIC
Other - Org Name:CENTER FOR VEIN RESTORATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SANJIV
Authorized Official - Middle Name:
Authorized Official - Last Name:LAKHANPAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:240-460-1073
Mailing Address - Street 1:12200 ANNAPOLIS RD
Mailing Address - Street 2:STE 225
Mailing Address - City:GLENN DALE
Mailing Address - State:MD
Mailing Address - Zip Code:20769-9182
Mailing Address - Country:US
Mailing Address - Phone:301-860-0930
Mailing Address - Fax:301-809-0929
Practice Address - Street 1:4217 EVERGREEN LN
Practice Address - Street 2:
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-3210
Practice Address - Country:US
Practice Address - Phone:301-886-8363
Practice Address - Fax:301-441-8806
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE MEDICAL CLINIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-02-03
Last Update Date:2010-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0053733174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCG00397OtherMEDICARE ID
MD893LOtherMEDICARE ID