Provider Demographics
NPI:1740735794
Name:FIRST CARE MEDICAL SERVICES CORPORATION
Entity type:Organization
Organization Name:FIRST CARE MEDICAL SERVICES CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RUSSOM
Authorized Official - Middle Name:B
Authorized Official - Last Name:GHEBRAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-502-6912
Mailing Address - Street 1:4150 STEVENSON ST
Mailing Address - Street 2:APT. 303
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-5774
Mailing Address - Country:US
Mailing Address - Phone:301-502-6912
Mailing Address - Fax:
Practice Address - Street 1:1310 SOUTHERN AVE SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-4623
Practice Address - Country:US
Practice Address - Phone:202-574-6000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-19
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty