Provider Demographics
NPI:1780855494
Name:INTERNAL MEDICINE OF ARLINGTON, PC
Entity Type:Organization
Organization Name:INTERNAL MEDICINE OF ARLINGTON, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MANDANA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAFAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-894-4000
Mailing Address - Street 1:1401 WILSON BLVD
Mailing Address - Street 2:STE 1007
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22209-2325
Mailing Address - Country:US
Mailing Address - Phone:703-894-4000
Mailing Address - Fax:
Practice Address - Street 1:1401 WILSON BLVD
Practice Address - Street 2:STE 1007
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22209-2325
Practice Address - Country:US
Practice Address - Phone:703-894-4000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-20
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101052152207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G45521Medicare UPIN