Provider Demographics
NPI:1538284724
Name:ENGLESIDE INTERNAL MEDICINE
Entity Type:Organization
Organization Name:ENGLESIDE INTERNAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:B
Authorized Official - Last Name:MEYERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-360-2445
Mailing Address - Street 1:8637 ENGLESIDE OFFICE PARK
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22309-4132
Mailing Address - Country:US
Mailing Address - Phone:703-360-2445
Mailing Address - Fax:703-360-7656
Practice Address - Street 1:8637 ENGLESIDE OFFICE PARK
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22309-4132
Practice Address - Country:US
Practice Address - Phone:703-360-2445
Practice Address - Fax:703-360-7656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101053970174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA661861Medicare ID - Type Unspecified