Organization
MEDICAL AVENUE INTERNAL MEDICINE PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ILIJA STEVEN RAKARIC (DIRECTOR / INCORPORATOR)
(540) 908-3095
Entity
Organization
Contact information
Practice address
1920 MEDICAL AVE, STE F, HARRISONBURG, VA 22801-8016
(540) 908-3095
(540) 908-3085
Mailing address
1920 MEDICAL AVE, STE F, HARRISONBURG, VA 22801-8016
(540) 908-3095
(540) 908-3085
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
0101054605
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
006023169
—
VA
01
—
1184734154
NPI
—
01
—
211236
ANTHEM
—
01
—
21467
OPTIMA HEALTH
—
Enumeration date
03/30/2015
Last updated
04/20/2015
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