Organization
GREAT FALLS GERIATRIC MEDICINE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CAROL REYBURN MARTIN MD (PHYSICIAN)
(703) 947-7377
Entity
Organization
Contact information
Practice address
10017 PARK ROYAL DR, GREAT FALLS, VA 22066-1847
(703) 947-7377
Mailing address
PO BOX 440, GREAT FALLS, VA 22066-0440
Taxonomy
Speciality
Code
Description
License number
State
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0101265405
MEDICAL LICENSE
VA
Enumeration date
12/23/2020
Last updated
12/23/2020
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