Provider Demographics
NPI:1700129194
Name:AXIOM HEALTH CORPORATION
Entity Type:Organization
Organization Name:AXIOM HEALTH CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:MARINA
Authorized Official - Middle Name:SUSANA
Authorized Official - Last Name:ABAD
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:703-459-4773
Mailing Address - Street 1:9707 SIGNAL CT
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20111-2505
Mailing Address - Country:US
Mailing Address - Phone:703-459-4773
Mailing Address - Fax:
Practice Address - Street 1:9707 SIGNAL CT
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20111-2505
Practice Address - Country:US
Practice Address - Phone:703-459-4773
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024167755261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0024167755OtherBOARD OF NURSING, NURSE PRACTITIONER LICENSE
VA1912174855OtherNPI
VA1912174855OtherNPI