Organization
MEDNOVATIONS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHANTAL D LEWIS MD (OWNER)
(301) 254-9444
Entity
Organization
Contact information
Practice address
1712 FINANCIAL LOOP, WOODBRIDGE, VA 22192-2459
(571) 989-4134
Mailing address
13010 SMOKETOWN RD, WOODBRIDGE, VA 22192-3367
(301) 254-9444
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1487817466
—
VA
Enumeration date
06/26/2018
Last updated
06/26/2018
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