| Old Town Manassas Medical Center | |
|
9003 Church St Manassas VA 20110-5410 | |
| (703) 365-0397 | |
| (703) 365-0399 |
| Full Name | Old Town Manassas Medical Center |
|---|---|
| Speciality | Clinic/center |
| Location | 9003 Church St, Manassas, Virginia |
| Authorized Official Name and Position | Flaviano Dazo (OWNER) |
| Authorized Official Contact | 7033650397 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Old Town Manassas Medical Center 9003 Church St Manassas VA 20110-5410 Ph: (703) 365-0397 | Old Town Manassas Medical Center 9003 Church St Manassas VA 20110-5410 Ph: (703) 365-0397 |
| NPI Number | 1184027161 |
|---|---|
| Provider Enumeration Date | 10/03/2014 |
| Last Update Date | 10/03/2014 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184027161 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 0663198-0 (Virginia) | Primary |
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