Organization
EHS CORPORATE CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN P MAMANA MD (OWNER)
(703) 230-6990
Entity
Organization
Contact information
Practice address
12040 S LAKES DR, SUITE 205, RESTON, VA 20191-1246
(703) 230-6990
(703) 230-6980
Mailing address
12040 S LAKES DR, SUITE 205, RESTON, VA 20191-1246
(703) 230-6990
(703) 230-6980
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
0101021602
VA
Other
Enumeration date
05/06/2010
Last updated
05/06/2010
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