Provider Demographics
NPI:1912142076
Name:WOODBRIDGE INTERNAL MEDICINE, PC
Entity Type:Organization
Organization Name:WOODBRIDGE INTERNAL MEDICINE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FARDIN
Authorized Official - Middle Name:
Authorized Official - Last Name:AKRAMI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-910-7390
Mailing Address - Street 1:2022 OPITZ BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-3323
Mailing Address - Country:US
Mailing Address - Phone:703-910-7390
Mailing Address - Fax:703-910-7392
Practice Address - Street 1:2022 OPITZ BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-3323
Practice Address - Country:US
Practice Address - Phone:703-910-7390
Practice Address - Fax:703-910-7392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-03
Last Update Date:2013-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAGC1195Medicare PIN