Provider Demographics
NPI:1629691266
Name:VIRGINIA FAMILY INTEGRATED MEDICINE
Entity Type:Organization
Organization Name:VIRGINIA FAMILY INTEGRATED MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CAMERON
Authorized Official - Middle Name:
Authorized Official - Last Name:HATAM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:703-370-5300
Mailing Address - Street 1:5130 DUKE ST # 114
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-2924
Mailing Address - Country:US
Mailing Address - Phone:703-370-5300
Mailing Address - Fax:703-370-0080
Practice Address - Street 1:5130 DUKE ST # 114
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-2924
Practice Address - Country:US
Practice Address - Phone:703-370-5300
Practice Address - Fax:703-370-0080
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VIRGINIA FAMILY CHIROPRACTIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-05-18
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty