Avicenna Health & Medical LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

0101251555 Issued in VA

Legal business name

AVICENNA HEALTH & MEDICAL LLC

Practice address

1860 Town Center Dr Ste 340
Reston, VA 20190-5912

Phone

(703) 943-7475

NPI assigned

Jan 11, 2017

Organization subpart

No

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

Authorized official

Name

Malika Manyam, M.D

Title

President

Phone

(810) 341-3295

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1484092800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1555286400000",
    "number": "1083150239",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2695",
            "city": "RESTON",
            "state": "VA",
            "postal_code": "201950695",
            "telephone_number": "703-943-7475"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1860 TOWN CENTER DR STE 340",
            "city": "RESTON",
            "state": "VA",
            "postal_code": "201905912",
            "telephone_number": "703-943-7475"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AVICENNA HEALTH & MEDICAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-01-11",
        "last_updated": "2019-04-15",
        "status": "A",
        "authorized_official_last_name": "MANYAM",
        "authorized_official_first_name": "MALIKA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "810-341-3295",
        "authorized_official_credential": "M.D"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "VA",
            "license": "0101251555",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Internal Medicine Physician in Reston, VA
• Providers in Reston, 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 15, 2019; 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.