Organization
INTEGRATIVE MEDICINE & WELLNESS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MARIYA BOURGET MD (OWNER)
(571) 659-4316
Entity
Organization
Contact information
Practice address
42029 BUSHCLOVER TERRACE, ALDIE, VA 20105
(571) 659-4316
(866) 611-2705
Mailing address
42029 BUSHCLOVER TERRACE, ALDIE, VA 20105
(571) 659-4316
(866) 611-2705
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
VV1662B
—
VA
Enumeration date
09/25/2023
Last updated
09/25/2023
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