Provider Demographics
NPI:1962751966
Name:PRIME MEDICAL CARE,LLC
Entity type:Organization
Organization Name:PRIME MEDICAL CARE,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BISHWAKARMA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-746-8408
Mailing Address - Street 1:8101 HINSON FARM RD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22306-3403
Mailing Address - Country:US
Mailing Address - Phone:703-746-8408
Mailing Address - Fax:703-746-8407
Practice Address - Street 1:8101 HINSON FARM RD
Practice Address - Street 2:SUITE 208
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22306-3403
Practice Address - Country:US
Practice Address - Phone:703-746-8408
Practice Address - Fax:703-746-8407
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-05
Last Update Date:2012-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101243193207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty