Provider Demographics
NPI:1528386224
Name:EHS CORPORATE CARE
Entity Type:Organization
Organization Name:EHS CORPORATE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:P
Authorized Official - Last Name:MAMANA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-230-6990
Mailing Address - Street 1:12040 S LAKES DR
Mailing Address - Street 2:SUITE 205
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20191-1246
Mailing Address - Country:US
Mailing Address - Phone:703-230-6990
Mailing Address - Fax:703-230-6980
Practice Address - Street 1:12040 S LAKES DR
Practice Address - Street 2:SUITE 205
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20191-1246
Practice Address - Country:US
Practice Address - Phone:703-230-6990
Practice Address - Fax:703-230-6980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-06
Last Update Date:2010-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101021602207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty