Organization
DOMINION FAMILY HEALTH, PLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISA KIMBERLY MALLOY MD (OWNER)
(703) 670-0067
Entity
Organization
Contact information
Practice address
5800 MAPLEDALE PLZ, DALE CITY, VA 22193-4535
(703) 670-0067
(703) 670-0301
Mailing address
5800 MAPLEDALE PLZ, DALE CITY, VA 22193-4535
(703) 670-0067
(703) 670-0301
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0101226862
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010031605
—
VA
01
—
1295729341
NPI
VA
Enumeration date
12/15/2006
Last updated
03/03/2010
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