Revive Medicine LLC

Primary specialty

Obesity Medicine (Family Medicine) PhysicianTaxonomy code 207QB0002X

Legal business name

REVIVE MEDICINE LLC

Practice address

3998 Fair Ridge Dr Ste 270
Fairfax, VA 22033-2907

Phone

(571) 544-8110

NPI assigned

Mar 14, 2023

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Nancy Selim, DONPI 1750516340

Title

Principal

Phone

(951) 741-7258

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Nancy Selim, D.O.

  • Family Medicine Physician
  • Burke, VA
  • NPI 1750516340
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1678752000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678752000000",
    "number": "1013618255",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5423 MARLSTONE LN",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220305834",
            "telephone_number": "951-741-7258"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3998 FAIR RIDGE DR STE 270",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220332907",
            "telephone_number": "571-544-8110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REVIVE MEDICINE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-03-14",
        "last_updated": "2023-03-14",
        "certification_date": "2023-03-14",
        "status": "A",
        "authorized_official_last_name": "SELIM",
        "authorized_official_first_name": "NANCY",
        "authorized_official_title_or_position": "PRINCIPAL",
        "authorized_official_telephone_number": "951-741-7258",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207QB0002X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine, Obesity Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Obesity Medicine (Family Medicine) Physician in Fairfax, VA
• Providers in Fairfax, VA by specialty
• Obesity Medicine (Family Medicine) Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.