# MOSAIC MEDICAL GROUP, LLC

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

## Provider details

- **NPI number:** 1356671457
- **Authorized official:** HOLLY NORTH (OFFICE MANAGER)
- **Authorized official phone:** (703) 393-0700

## Contact information

- **Practice address:** 8525 ROLLING RD, SUITE 222, MANASSAS, VA 20110-3647
- **Practice address phone:** (703) 393-0720
- **Practice address fax:** (703) 334-0750
- **Mailing address:** 8525 ROLLING RD, SUITE 220, MANASSAS, VA 20110-3647
- **Mailing address phone:** (703) 393-0700
- **Mailing address fax:** (703) 393-0661

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | — | NULL | Yes |
| 208D00000X | General Practice Physician | — | — | Yes |

## Other

- **Enumeration date:** 01/12/2010
- **Last updated:** 11/15/2013