| Alphatelemed.com | |
|
2615 Columbia Pike Bsmt Suite200 Arlington VA 22204 | |
| (818) 445-0139 | |
| (949) 404-6967 |
| Full Name | Alphatelemed.com |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 2615 Columbia Pike Bsmt Suite200, Arlington, Virginia |
| Authorized Official Name and Position | Mubin Jiwani (MANAGING MEMBER) |
| Authorized Official Contact | 7035899964 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Alphatelemed.com 10622 Runaway Ln Great Falls VA 22066-2420 Ph: (703) 589-9964 | Alphatelemed.com 2615 Columbia Pike Bsmt Suite200 Arlington VA 22204 Ph: (818) 445-0139 |
| NPI Number | 1295393791 |
|---|---|
| Provider Enumeration Date | 05/30/2019 |
| Last Update Date | 12/23/2022 |
| Certification Date | 12/23/2022 |
| Medicare PECOS PAC ID | 7618203050 |
|---|---|
| Medicare Enrollment ID | O20190724000025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295393791 | NPI | - | NPPES |
| 1619412673 | Medicaid | VA | |
| 1487176053 | Medicaid | VA | |
| 1114459732 | Other | VA | NPI |
| 1841554912 | Medicaid | VA | |
| 1336543032 | Medicaid | VA | |
| 1548488927 | Medicaid | VA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| 363LF0000X | Nurse Practitioner - Family | (* (Not Available)) | Secondary |
| Provider Name | Brandie N Bustillos |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548488927 PECOS PAC ID: 2668570706 Enrollment ID: I20070613000296 |
| Provider Name | Zahra Hussain |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487176053 PECOS PAC ID: 7012283070 Enrollment ID: I20171019001891 |
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