Provider Demographics
NPI:1831278738
Name:LANSDOWNE TRAVEL AND FAMILY MEDICINE LLC
Entity type:Organization
Organization Name:LANSDOWNE TRAVEL AND FAMILY MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAJIV
Authorized Official - Middle Name:KUMAR
Authorized Official - Last Name:AGGARWAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:571-223-3833
Mailing Address - Street 1:19415 DEERFIELD AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:LANSDOWNE
Mailing Address - State:VA
Mailing Address - Zip Code:20176-8452
Mailing Address - Country:US
Mailing Address - Phone:571-223-3833
Mailing Address - Fax:877-260-8179
Practice Address - Street 1:19415 DEERFIELD AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:LANSDOWNE
Practice Address - State:VA
Practice Address - Zip Code:20176-8452
Practice Address - Country:US
Practice Address - Phone:571-223-3833
Practice Address - Fax:877-260-8179
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2014-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101232243207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010103878Medicaid
VAC09224Medicare PIN
VAH13531Medicare UPIN
DCG01880Medicare PIN