Provider Demographics
NPI:1598291791
Name:ONE HEALTH MEDICAL CARE, LLC
Entity Type:Organization
Organization Name:ONE HEALTH MEDICAL CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:MINGLIARTI
Authorized Official - Middle Name:
Authorized Official - Last Name:TJAHJANA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:571-572-9198
Mailing Address - Street 1:1850 TOWN CENTER DRIVE
Mailing Address - Street 2:SUITE 410
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-3219
Mailing Address - Country:US
Mailing Address - Phone:571-572-9054
Mailing Address - Fax:571-482-6080
Practice Address - Street 1:1850 TOWN CENTER DRIVE
Practice Address - Street 2:SUITE 410
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-3219
Practice Address - Country:US
Practice Address - Phone:571-572-9054
Practice Address - Fax:571-482-6080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-08
Last Update Date:2017-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101236144207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty