NPIMap

Organization Active NPI

Dominion Medical Center, LLC

  • Internal Medicine Physician
  • King George, VA
National Provider Identifier
1114109261
Registry record updated Mar 17, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
DOMINION MEDICAL CENTER, LLC
Practice address
11463 Ridge Rd
King George, VA 22485-4078
Phone
(301) 870-3540
Fax
(301) 392-1726
NPI assigned
Nov 30, 2007
Last updated
Mar 17, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2008

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

Authorized official

Name
Maryann Ayers
Title
Administrator
Phone
(301) 870-3540

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207R00000X Primary

Addresses

Primary practice location

11463 Ridge Rd
King George, VA 22485-4078

Mailing address

11463 Ridge Rd
P.O. Box 999
King George, VA 22485-4078
Phone (301) 870-3540

National Provider Directory

National Provider Directory

Locations

11463 Ridge Rd
King George, VA 22485
Phone (540) 775-9200

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1196380800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1205712000000",
    "number": "1114109261",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11463 RIDGE RD",
            "address_2": "P.O. BOX 999",
            "city": "KING GEORGE",
            "state": "VA",
            "postal_code": "224854078",
            "telephone_number": "301-870-3540",
            "fax_number": "301-392-1726"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11463 RIDGE RD",
            "city": "KING GEORGE",
            "state": "VA",
            "postal_code": "224854078",
            "telephone_number": "301-870-3540",
            "fax_number": "301-392-1726"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DOMINION MEDICAL CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-30",
        "last_updated": "2008-03-17",
        "status": "A",
        "authorized_official_last_name": "AYERS",
        "authorized_official_first_name": "MARYANN",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "301-870-3540"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in King George, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2008; 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.