Provider Demographics
NPI:1508212184
Name:HONEST MEDICAL WEIGHT LOSS LLC
Entity Type:Organization
Organization Name:HONEST MEDICAL WEIGHT LOSS LLC
Other - Org Name:HONEST MEDICAL WEIGHT LOSS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:LUCAS
Authorized Official - Middle Name:
Authorized Official - Last Name:BRAGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-230-5555
Mailing Address - Street 1:4500 SOUTHGATE PL STE 200
Mailing Address - Street 2:
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20151-1714
Mailing Address - Country:US
Mailing Address - Phone:703-230-5555
Mailing Address - Fax:703-661-6937
Practice Address - Street 1:4500 SOUTHGATE PL STE 200
Practice Address - Street 2:
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20151-1714
Practice Address - Country:US
Practice Address - Phone:703-230-5555
Practice Address - Fax:703-661-6937
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-12
Last Update Date:2017-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QB0002XAllopathic & Osteopathic PhysiciansFamily MedicineObesity MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1508212184OtherIRS