Provider Demographics
NPI:1609804285
Name:MANASSAS INTERNAL MEDICINE PC
Entity Type:Organization
Organization Name:MANASSAS INTERNAL MEDICINE PC
Other - Org Name:MANASSAS INTERNAL MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAMEL
Authorized Official - Suffix:
Authorized Official - Credentials:CMOM,CMC
Authorized Official - Phone:703-257-7749
Mailing Address - Street 1:8569 SUDLEY RD STE B
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-3866
Mailing Address - Country:US
Mailing Address - Phone:703-257-7749
Mailing Address - Fax:855-254-4529
Practice Address - Street 1:8569 SUDLEY RD STE B
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-3866
Practice Address - Country:US
Practice Address - Phone:703-257-7749
Practice Address - Fax:855-254-4529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-30
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC05640Medicare PIN