Organization
PENDERBROOK INTERNAL MEDICINE AND WELLNESS, PLLC
Active
Organization
PENDERBROOK INTERNAL MEDICINE AND WELLNESS, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THIEN QUANG DAT LE M.D. (OWNER)
(703) 716-5404
Entity
Organization
Contact information
Practice address
4001 FAIR RIDGE DR, SUITE 206, FAIRFAX, VA 22033-2917
(703) 716-5404
(703) 716-5410
Mailing address
4001 FAIR RIDGE DR, SUITE 206, FAIRFAX, VA 22033-2917
(703) 716-5404
(703) 716-5410
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
0101840408
VA
Other
Enumeration date
12/08/2009
Last updated
09/29/2011
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