Trident Medical Group LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

TRIDENT MEDICAL GROUP LLC

Practice address

19415 Deerfield Ave Ste 103
Lansdowne, VA 20176-8470

Phone

(703) 509-9198

NPI assigned

Aug 3, 2021

Organization subpart

No

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

Authorized official

Name

Naresh Bassi, MD, FACP, FHM

Title

President

Phone

(703) 509-9198

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1627948800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1649116800000",
    "number": "1043984115",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "42115 PEMBERLY CT",
            "city": "CHANTILLY",
            "state": "VA",
            "postal_code": "201525982",
            "telephone_number": "703-509-9198"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19415 DEERFIELD AVE STE 103",
            "city": "LANSDOWNE",
            "state": "VA",
            "postal_code": "201768470",
            "telephone_number": "703-509-9198"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "44045 Riverside Pkwy",
            "address_purpose": "LOCATION",
            "city": "Leesburg",
            "state": "VA",
            "postal_code": "201765101",
            "country_code": "US",
            "telephone_number": "703-509-9198",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "42115 Pemberly Ct",
            "address_purpose": "LOCATION",
            "city": "Chantilly",
            "state": "VA",
            "postal_code": "201525982",
            "country_code": "US",
            "telephone_number": "703-509-9198",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "TRIDENT MEDICAL GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-03",
        "last_updated": "2022-04-05",
        "certification_date": "2022-04-05",
        "status": "A",
        "authorized_official_last_name": "BASSI",
        "authorized_official_first_name": "NARESH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "703-509-9198",
        "authorized_official_credential": "MD, FACP, FHM"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Internal Medicine Physician in Lansdowne, VA
• Providers in Lansdowne, VA by specialty
• Internal Medicine Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 5, 2022; 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.