Provider Demographics
NPI:1205250172
Name:LEESBURG INTERNAL MEDICINE AND AND PRIMARY CARE LLC
Entity type:Organization
Organization Name:LEESBURG INTERNAL MEDICINE AND AND PRIMARY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ASIMA
Authorized Official - Middle Name:SALEEM
Authorized Official - Last Name:QUIDWAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-775-8402
Mailing Address - Street 1:19455 DEERFIELD AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-8100
Mailing Address - Country:US
Mailing Address - Phone:757-775-8402
Mailing Address - Fax:
Practice Address - Street 1:20093 WHISTLING STRAITS PL
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-3196
Practice Address - Country:US
Practice Address - Phone:757-775-8402
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LEESBURG INTERNAL MEDICINE AND AND PRIMARY CARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-02-12
Last Update Date:2014-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty