Provider Demographics
NPI:1154561389
Name:ALTMED MEDICAL CENTER, INC
Entity type:Organization
Organization Name:ALTMED MEDICAL CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:K
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:703-361-4357
Mailing Address - Street 1:P.O. BOX 2041
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20108-0815
Mailing Address - Country:US
Mailing Address - Phone:703-361-4357
Mailing Address - Fax:703-361-0346
Practice Address - Street 1:8551 RIXLEW LANE
Practice Address - Street 2:SUITE 140
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20109-4278
Practice Address - Country:US
Practice Address - Phone:703-361-4357
Practice Address - Fax:703-361-0346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-27
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2083A0300X, 2083P0500X, 208D00000X
MDD0054211208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083A0300XAllopathic & Osteopathic PhysiciansPreventive MedicineAddiction MedicineGroup - Multi-Specialty
No2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental MedicineGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty