Provider Demographics
NPI:1649662339
Name:CRESCENT MEDICAL ARTS
Entity type:Organization
Organization Name:CRESCENT MEDICAL ARTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TAREQ
Authorized Official - Middle Name:
Authorized Official - Last Name:ABEDIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-729-9220
Mailing Address - Street 1:19415 DEERFIELD AVE
Mailing Address - Street 2:SUITE 213
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-8452
Mailing Address - Country:US
Mailing Address - Phone:703-729-9220
Mailing Address - Fax:703-858-3529
Practice Address - Street 1:19415 DEERFIELD AVE
Practice Address - Street 2:SUITE 213
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-8452
Practice Address - Country:US
Practice Address - Phone:703-729-9220
Practice Address - Fax:703-858-3529
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-04
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101053554207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty