Organization
CCRM NORTHERN VIRGINIA, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MATT TYSON (DIRECTOR, MANAGED CARE CONTRACTING)
(615) 477-6677
Entity
Organization
Contact information
Practice address
8010 TOWERS CRESCENT DR FL 5, VIENNA, VA 22182-2710
(571) 789-2100
Mailing address
8010 TOWERS CRESCENT DR FL 5, VIENNA, VA 22182-2710
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
49D2129549
CLIA
—
Enumeration date
02/25/2020
Last updated
07/13/2026
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