Provider Demographics
NPI:1659660413
Name:MOUNT VERNON INTERNAL MEDICINE
Entity Type:Organization
Organization Name:MOUNT VERNON INTERNAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:HERRERA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-780-2800
Mailing Address - Street 1:8101 HINSON FARM RD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22306-3403
Mailing Address - Country:US
Mailing Address - Phone:703-780-2800
Mailing Address - Fax:
Practice Address - Street 1:8101 HINSON FARM RD
Practice Address - Street 2:SUITE 108
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22306-3403
Practice Address - Country:US
Practice Address - Phone:703-780-2800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-01
Last Update Date:2011-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty