| Dominion Family Health, Plc | |
|
5800 Mapledale Plz Dale City VA 22193-4535 | |
| (703) 670-0067 | |
| (703) 670-0301 |
| Full Name | Dominion Family Health, Plc |
|---|---|
| Speciality | Family Medicine |
| Location | 5800 Mapledale Plz, Dale City, Virginia |
| Authorized Official Name and Position | Lisa Kimberly Malloy (OWNER) |
| Authorized Official Contact | 7036700067 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Dominion Family Health, Plc 5800 Mapledale Plz Dale City VA 22193-4535 Ph: (703) 670-0067 | Dominion Family Health, Plc 5800 Mapledale Plz Dale City VA 22193-4535 Ph: (703) 670-0067 |
| NPI Number | 1952463606 |
|---|---|
| Provider Enumeration Date | 12/15/2006 |
| Last Update Date | 03/03/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1952463606 | NPI | - | NPPES |
| 1295729341 | Other | VA | NPI |
| 010031605 | Medicaid | VA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 0101226862 (Virginia) | Primary |
Northern Virginia Family Care Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 4101 Cheshire Station Plaza, Suite 500, Dale City, VA 22193 Phone: 571-374-1234 |