NPIMap

Organization Active NPI

Sudley Medical Clinic Inc

  • Family Medicine Physician
  • Manassas, VA
National Provider Identifier
1174829782
Registry record updated Sep 28, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
0101239873 Issued in VA
Legal business name
SUDLEY MEDICAL CLINIC INC
Practice address
10757 Ambassador Dr
Suite 101
Manassas, VA 20109-2522
Phone
(703) 626-7501
Fax
(571) 379-7468
NPI assigned
Jan 28, 2011
Last updated
Sep 28, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 28, 2012

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

Authorized official

Name
Mrs. Maria E Mendoza
Title
Office Manager
Phone
(703) 626-7501

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 0101239873 VA Primary

Addresses

Primary practice location

10757 Ambassador Dr
Suite 101
Manassas, VA 20109-2522

Mailing address

10757 Ambassador Dr
Suite 101
Manassas, VA 20109-2522
Phone (703) 626-7501

National Provider Directory

National Provider Directory

Locations

10757 Ambassador Dr
Ste 101
Manassas, VA 20109
Phone (571) 379-7395

Practitioners & affiliated clinicians

Practitioners 1

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": "1296172800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1348790400000",
    "number": "1174829782",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10757 AMBASSADOR DR",
            "address_2": "SUITE 101",
            "city": "MANASSAS",
            "state": "VA",
            "postal_code": "201092522",
            "telephone_number": "703-626-7501",
            "fax_number": "571-379-7468"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10757 AMBASSADOR DR",
            "address_2": "SUITE 101",
            "city": "MANASSAS",
            "state": "VA",
            "postal_code": "201092522",
            "telephone_number": "703-626-7501",
            "fax_number": "571-379-7468"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUDLEY MEDICAL CLINIC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-01-28",
        "last_updated": "2012-09-28",
        "status": "A",
        "authorized_official_last_name": "MENDOZA",
        "authorized_official_first_name": "MARIA",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "703-626-7501",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "VA",
            "license": "0101239873",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Manassas, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2012; 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.