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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