Provider Demographics
NPI:1568993855
Name:CCRM VIRGINIA
Entity Type:Organization
Organization Name:CCRM VIRGINIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:PAYSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:5717-892-1005
Mailing Address - Street 1:8010 TOWERS CRESCENT DR
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-2710
Mailing Address - Country:US
Mailing Address - Phone:571-789-2100
Mailing Address - Fax:
Practice Address - Street 1:8010 TOWERS CRESCENT DR
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-2710
Practice Address - Country:US
Practice Address - Phone:571-789-2100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-27
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101243183207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive EndocrinologyGroup - Single Specialty