| Dulles Health Llc | |
|
4080 Lafayette Center Dr Suite # 110 Chantilly VA 20151-1247 | |
| (703) 961-1680 | |
| Not Available |
| Full Name | Dulles Health Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 4080 Lafayette Center Dr, Chantilly, Virginia |
| Authorized Official Name and Position | Vijaya L Gorle (PRINCIPAL) |
| Authorized Official Contact | 7039611680 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dulles Health Llc 4080 Lafayette Center Dr Suite # 110 Chantilly VA 20151-1247 Ph: (703) 961-1680 | Dulles Health Llc 4080 Lafayette Center Dr Suite # 110 Chantilly VA 20151-1247 Ph: (703) 961-1680 |
| NPI Number | 1093933723 |
|---|---|
| Provider Enumeration Date | 04/20/2007 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 1759329600 |
|---|---|
| Medicare Enrollment ID | O20050525000512 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093933723 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 0101235079 (Virginia) | Primary |
| Provider Name | Vijaya L Gorle |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1750371803 PECOS PAC ID: 8921097262 Enrollment ID: I20050525000560 |
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