Organization
AVICENNA HEALTH & MEDICAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MALIKA MANYAM M.D (PRESIDENT)
(810) 341-3295
Entity
Organization
Contact information
Practice address
1860 TOWN CENTER DR STE 340, RESTON, VA 20190-5912
(703) 943-7475
Mailing address
PO BOX 2695, RESTON, VA 20195-0695
(703) 943-7475
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
0101251555
VA
Other
Enumeration date
01/11/2017
Last updated
04/15/2019
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