| Dulles Family Medicine P.c. | |
|
504 Elden St # 3 Herndon VA 20170-4741 | |
| (703) 471-0800 | |
| (703) 471-1332 |
| Full Name | Dulles Family Medicine P.c. |
|---|---|
| Speciality | Family Medicine |
| Location | 504 Elden St # 3, Herndon, Virginia |
| Authorized Official Name and Position | Shamim Akhtar Iman (OWNER OF PRACTICE C CORPORATION) |
| Authorized Official Contact | 7034710800 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dulles Family Medicine P.c. 504 Elden St # 3 Herndon VA 20170-4741 Ph: (703) 471-0800 | Dulles Family Medicine P.c. 504 Elden St # 3 Herndon VA 20170-4741 Ph: (703) 471-0800 |
| NPI Number | 1295760510 |
|---|---|
| Provider Enumeration Date | 07/12/2006 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 7517068505 |
|---|---|
| Medicare Enrollment ID | O20070720000267 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295760510 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 0101046800 (Virginia) | Primary |
| Provider Name | Shamim A Imam |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1265513550 PECOS PAC ID: 2860595550 Enrollment ID: I20070319000214 |
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