Provider Demographics
NPI:1851565444
Name:PHYSICIAN PRACTICE & RESEARCH LLC
Entity Type:Organization
Organization Name:PHYSICIAN PRACTICE & RESEARCH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OSCAR
Authorized Official - Middle Name:
Authorized Official - Last Name:ADLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-723-5555
Mailing Address - Street 1:9104 STREAMVIEW LN
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-1728
Mailing Address - Country:US
Mailing Address - Phone:703-723-5555
Mailing Address - Fax:703-391-5007
Practice Address - Street 1:19415 DEERFIELD AVE
Practice Address - Street 2:SUITE #107
Practice Address - City:LANSDOWNE
Practice Address - State:VA
Practice Address - Zip Code:20176-8452
Practice Address - Country:US
Practice Address - Phone:703-723-5555
Practice Address - Fax:703-562-6996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-15
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0063101207RN0300X
VA0101234619207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDI29106Medicare UPIN