NPIMap

Organization Active NPI

Clinica of Virginia LLC

  • Internal Medicine Physician
  • Fairfax, VA
National Provider Identifier
1174841324
Registry record updated May 12, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
CLINICA OF VIRGINIA LLC
Practice address
10560 Main St
#215
Fairfax, VA 22030-7182
Phone
(571) 432-0700
NPI assigned
May 12, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 12, 2010

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

Authorized official

Name
Mr. Woodrow Allen Boyer, EGM
Title
Executive General Manager
Phone
(863) 614-0371

Specialties & licenses 1

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

Addresses

Primary practice location

10560 Main St
#215
Fairfax, VA 22030-7182

Mailing address

1600 Tysons Blvd
8TH Floor
MC Lean, VA 22102-4865
Phone (703) 245-8513

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1273622400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1273622400000",
    "number": "1174841324",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 TYSONS BLVD",
            "address_2": "8TH FLOOR",
            "city": "MC LEAN",
            "state": "VA",
            "postal_code": "221024865",
            "telephone_number": "703-245-8513",
            "fax_number": "703-245-3001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10560 MAIN ST",
            "address_2": "#215",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220307182",
            "telephone_number": "571-432-0700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLINICA OF VIRGINIA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-05-12",
        "last_updated": "2010-05-12",
        "status": "A",
        "authorized_official_last_name": "BOYER",
        "authorized_official_first_name": "WOODROW",
        "authorized_official_middle_name": "ALLEN",
        "authorized_official_title_or_position": "EXECUTIVE GENERAL MANAGER",
        "authorized_official_telephone_number": "863-614-0371",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "EGM"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairfax, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2010; 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.