Organization
HEALTH CONNECT IPA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LAURI RUSTAND (EXECUTIVE DIRECTOR)
(703) 391-2042
Entity
Organization
Contact information
Practice address
12011 LEE JACKSON MEMORIAL HWY, SUITE 504, FAIRFAX, VA 22033-3310
(703) 391-2042
(703) 273-3943
Mailing address
12011 LEE JACKSON MEMORIAL HWY, SUITE 504, FAIRFAX, VA 22033-3310
(703) 391-2042
(703) 273-3943
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
207R00000X
Internal Medicine Physician
—
—
208000000X
Pediatrics Physician
—
—
Other
Enumeration date
01/17/2013
Last updated
07/09/2013
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