Provider Demographics
NPI:1972538817
Name:INTERNAL MEDICINE OF STAFFORD
Entity Type:Organization
Organization Name:INTERNAL MEDICINE OF STAFFORD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NIBEDITA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOHANTY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-658-9340
Mailing Address - Street 1:422 GARRISONVILLE RD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22554-1573
Mailing Address - Country:US
Mailing Address - Phone:540-658-9340
Mailing Address - Fax:540-658-9344
Practice Address - Street 1:422 GARRISONVILLE RD
Practice Address - Street 2:SUITE 108
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-1573
Practice Address - Country:US
Practice Address - Phone:540-658-9340
Practice Address - Fax:540-658-9344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101045978207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty