Organization
NORTHERN VIRGINIA INTERNAL MEDICINE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LAURENCE J CLARK M.D. (PRESIDENT)
(703) 799-7300
Entity
Organization
Contact information
Practice address
8101 HINSON FARM RD, SUITE 119, ALEXANDRIA, VA 22306-3403
(703) 799-7300
(703) 799-8767
Mailing address
8101 HINSON FARM ROAD, SUITE 119, ALEXANDRIA, VA 22306
(703) 799-7300
(703) 799-8767
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
0101030440
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
006086659
—
VA
01
—
065941
ANTHEM BLUECROSS BLUESHIELD
VA
01
—
CC2176
PALMETTO MEDICARE RAILROAD
DC
Enumeration date
03/20/2007
Last updated
12/01/2009
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