Provider Demographics
NPI:1992312029
Name:VITAL CARE ENDOCRINOLOGY, LLC
Entity type:Organization
Organization Name:VITAL CARE ENDOCRINOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NEEHARIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:REPAKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:540-889-0199
Mailing Address - Street 1:1830 TOWN CENTER DR STE 306
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-3217
Mailing Address - Country:US
Mailing Address - Phone:571-450-8300
Mailing Address - Fax:571-450-8301
Practice Address - Street 1:1830 TOWN CENTER DR STE 306
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-3217
Practice Address - Country:US
Practice Address - Phone:571-450-8300
Practice Address - Fax:571-450-8301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-23
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty