49D2068814 CLIA NUMBER - MOUNT VERNON INTERNAL MEDICINE

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Laboratory Demographics

CLIA Number: 49D2068814

Facility Name: MOUNT VERNON INTERNAL MEDICINE

Facility Address:
8988 LORTON STATION BOULEVARD - SUITE 100
LORTON, VA
ZIP 22079
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Facility Phone Number: 703 780-2800

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1659660413

Taxonomy: 2085R0202X - Radiology
A radiologist who utilizes x-ray, radionuclides, ultrasound and electromagnetic radiation to diagnose and treat disease.

CLIA Record

Field Name	Field Value
CLIA Number	49D2068814
LAB Type	Physician Office
Facility Name	MOUNT VERNON INTERNAL MEDICINE
Street	8988 LORTON STATION BOULEVARD - SUITE 100
City	LORTON
State	VA
ZIP	22079
Phone	703 780-2800
CertificateType	4
CertificateEffectiveDate	8/31/2023
CertificateExpirationDate	8/30/2025
FacilityType	Waiver

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