| Old Dominion Medical Center, P.c. | |
|
6715 Whittier Avenue Suite 100 Mclean VA 22101 | |
| (703) 356-5700 | |
| (703) 448-8211 |
| Full Name | Old Dominion Medical Center, P.c. |
|---|---|
| Speciality | Family Medicine |
| Location | 6715 Whittier Avenue, Mclean, Virginia |
| Authorized Official Name and Position | Allen Bernard Horne (PHYSICIAN OWNER) |
| Authorized Official Contact | 7033565700 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Old Dominion Medical Center, P.c. 6715 Whittier Avenue Suite 100 Mclean VA 22101 Ph: (703) 356-5700 | Old Dominion Medical Center, P.c. 6715 Whittier Avenue Suite 100 Mclean VA 22101 Ph: (703) 356-5700 |
| NPI Number | 1104990167 |
|---|---|
| Provider Enumeration Date | 11/20/2006 |
| Last Update Date | 02/04/2016 |
| Medicare PECOS PAC ID | 3971545583 |
|---|---|
| Medicare Enrollment ID | O20050524001004 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104990167 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Allen Horne |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1225178296 PECOS PAC ID: 2163695008 Enrollment ID: I20120313000027 |
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