| Active Medical Care LLC | |
|
3930 Pender Dr Ste 230 Fairfax VA 22030-0992 | |
| (703) 620-6221 | |
| (703) 620-6628 |
| Full Name | Active Medical Care LLC |
|---|---|
| Speciality | Internal Medicine |
| Location | 3930 Pender Dr Ste 230, Fairfax, Virginia |
| Authorized Official Name and Position | Khairunnisa Masood (OWNER) |
| Authorized Official Contact | 7039878165 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Active Medical Care LLC 4879 Mayde Ct Fairfax VA 22030-6618 Ph: (703) 620-6221 | Active Medical Care LLC 3930 Pender Dr Ste 230 Fairfax VA 22030-0992 Ph: (703) 620-6221 |
| NPI Number | 1073757662 |
|---|---|
| Provider Enumeration Date | 04/27/2009 |
| Last Update Date | 11/03/2025 |
| Certification Date | 11/03/2025 |
| Medicare PECOS PAC ID | 5890216923 |
|---|---|
| Medicare Enrollment ID | O20250305003597 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073757662 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 0101237882 (Virginia) | Primary |
| Provider Name | Khairunnisa Masood |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1093731499 PECOS PAC ID: 2567461197 Enrollment ID: I20061208000530 |
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