Provider Demographics
NPI:1598761249
Name:PTAB LLC
Entity Type:Organization
Organization Name:PTAB LLC
Other - Org Name:AHH LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:HUGH
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:BRADIN
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:703-433-0401
Mailing Address - Street 1:21475 RIDGETOP CIR
Mailing Address - Street 2:STE 260
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20166-8580
Mailing Address - Country:US
Mailing Address - Phone:703-433-0401
Mailing Address - Fax:703-433-0490
Practice Address - Street 1:21475 RIDGETOP CIRCLE SUITE 260
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20166-6580
Practice Address - Country:US
Practice Address - Phone:703-433-0401
Practice Address - Fax:703-433-0490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-27
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAB501869174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC08855Medicare ID - Type UnspecifiedFACILITY ID