Provider Demographics
NPI:1598060691
Name:MED URGENT CARE LLC
Entity Type:Organization
Organization Name:MED URGENT CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRAHIM
Authorized Official - Middle Name:
Authorized Official - Last Name:ELOUARDIGHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-864-9159
Mailing Address - Street 1:4082 AIRLINE PKWY
Mailing Address - Street 2:
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20151-3979
Mailing Address - Country:US
Mailing Address - Phone:703-864-9159
Mailing Address - Fax:703-847-3189
Practice Address - Street 1:24430 MILLSTREAM DR
Practice Address - Street 2:
Practice Address - City:STONE RIDGE
Practice Address - State:VA
Practice Address - Zip Code:20105-3098
Practice Address - Country:US
Practice Address - Phone:703-864-9159
Practice Address - Fax:703-847-3189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-20
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101236263207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAI36993Medicare UPIN