49D0863267 CLIA NUMBER - INTERNAL MEDICINE PRACTICE PC

Laboratory Demographics

CLIA Number: 49D0863267

Facility Name: INTERNAL MEDICINE PRACTICE PC

Facility Address:
8233 A OLD COURT HOUSE ROAD - SUITE 170
VIENNA, VA
ZIP 22182
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Facility Phone Number: 703 556-9318

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1013121508

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	49D0863267
LAB Type	Physician Office
Facility Name	INTERNAL MEDICINE PRACTICE PC
Street	8233 A OLD COURT HOUSE ROAD - SUITE 170
City	VIENNA
State	VA
ZIP	22182
Phone	703 556-9318
CertificateType	4
CertificateEffectiveDate	9/1/2022
CertificateExpirationDate	8/31/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024