Provider Demographics
NPI:1982061297
Name:VIRGINIA INTEGRATIVE MEDICAL LLC
Entity Type:Organization
Organization Name:VIRGINIA INTEGRATIVE MEDICAL LLC
Other - Org Name:VIRGINIA INTEGRATIVE MEDICAL LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ABEL
Authorized Official - Middle Name:COSTAS
Authorized Official - Last Name:BORROMEO
Authorized Official - Suffix:V
Authorized Official - Credentials:DC
Authorized Official - Phone:540-550-3656
Mailing Address - Street 1:125 PROSPERITY DR
Mailing Address - Street 2:SUITE 500
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22602-5385
Mailing Address - Country:US
Mailing Address - Phone:540-550-3656
Mailing Address - Fax:540-868-0166
Practice Address - Street 1:125 PROSPERITY DR
Practice Address - Street 2:SUITE 500
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22602-5385
Practice Address - Country:US
Practice Address - Phone:540-550-3656
Practice Address - Fax:540-868-0166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-19
Last Update Date:2016-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556472261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service