Organization
PRIMA MEDGOV
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHETHANA V RAO MD (PRESIDENT)
(703) 879-3750
Entity
Organization
Contact information
Practice address
3903 FAIR RIDGE DR STE 218, FAIRFAX, VA 22033-2945
(703) 870-3750
Mailing address
3903 FAIR RIDGE DR STE 218, FAIRFAX, VA 22033-2945
(703) 870-3750
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
261QM1300X
Multi-Specialty Clinic/Center
—
—
261QP2300X
Primary Care Clinic/Center
—
—
Other
Enumeration date
01/29/2022
Last updated
01/29/2022
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