# REVIVE MEDICINE LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1013618255
- **Authorized official:** DR. NANCY SELIM DO (PRINCIPAL)
- **Authorized official phone:** (951) 741-7258

## Contact information

- **Practice address:** 3998 FAIR RIDGE DR STE 270, FAIRFAX, VA 22033-2907
- **Practice address phone:** (571) 544-8110
- **Mailing address:** 5423 MARLSTONE LN, FAIRFAX, VA 22030-5834
- **Mailing address phone:** (951) 741-7258

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207QB0002X | Obesity Medicine (Family Medicine) Physician | — | — | Yes |

## Other

- **Enumeration date:** 03/14/2023
- **Last updated:** 03/14/2023