Provider Demographics
NPI:1649705443
Name:INTEGRATIVE PHYSICIANS, LLC
Entity type:Organization
Organization Name:INTEGRATIVE PHYSICIANS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RAMESH
Authorized Official - Middle Name:
Authorized Official - Last Name:GOGINENI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-864-7870
Mailing Address - Street 1:44121 HARRY BYRD HWY STE 250
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20147-5674
Mailing Address - Country:US
Mailing Address - Phone:703-864-7870
Mailing Address - Fax:703-935-1303
Practice Address - Street 1:44121 HARRY BYRD HWY STE 250
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-5674
Practice Address - Country:US
Practice Address - Phone:703-864-7870
Practice Address - Fax:703-935-1303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-29
Last Update Date:2017-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center