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Organization
REVIVE MEDICINE LLC
Active
Organization
REVIVE MEDICINE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. NANCY SELIM DO (PRINCIPAL)
(951) 741-7258
Entity
Organization
Contact information
Practice address
3998 FAIR RIDGE DR STE 270, FAIRFAX, VA 22033-2907
(571) 544-8110
Mailing address
5423 MARLSTONE LN, FAIRFAX, VA 22030-5834
(951) 741-7258
Taxonomy
Speciality
Code
Description
License number
State
207QB0002X
Obesity Medicine (Family Medicine) Physician
Primary
—
—
Other
Enumeration date
03/14/2023
Last updated
03/14/2023
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