Provider Demographics
NPI:1881228021
Name:LIFESTYLE PHYSICIANS LLC
Entity Type:Organization
Organization Name:LIFESTYLE PHYSICIANS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:SAGAR
Authorized Official - Middle Name:
Authorized Official - Last Name:VERMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-829-5773
Mailing Address - Street 1:147 ALEXANDRIA PIKE STE 104
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:VA
Mailing Address - Zip Code:20186-2947
Mailing Address - Country:US
Mailing Address - Phone:540-680-2426
Mailing Address - Fax:
Practice Address - Street 1:12330 PINECREST RD STE 125
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20191-1655
Practice Address - Country:US
Practice Address - Phone:540-680-2426
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIFESTYLE PHYSICIANS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-02-26
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0101253031OtherSTATE LICENSE