Provider Demographics
NPI:1902126949
Name:MIDDLEBURG NEUROMUSCULAR MEDICINE AND REHABILITATION, PLC
Entity Type:Organization
Organization Name:MIDDLEBURG NEUROMUSCULAR MEDICINE AND REHABILITATION, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MD
Authorized Official - Prefix:DR
Authorized Official - First Name:DOMINIQUE
Authorized Official - Middle Name:L
Authorized Official - Last Name:VINH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-909-1882
Mailing Address - Street 1:22575 LEANNE TERRACE
Mailing Address - Street 2:UNIT 426
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20148
Mailing Address - Country:US
Mailing Address - Phone:703-909-1882
Mailing Address - Fax:
Practice Address - Street 1:24430 MILLSTREAM DRIVE
Practice Address - Street 2:
Practice Address - City:ALDIE
Practice Address - State:VA
Practice Address - Zip Code:20105
Practice Address - Country:US
Practice Address - Phone:703-909-1882
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-01
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101047558208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
F55781Medicare UPIN