Medical Clinic of Woodbridge Inc

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

0101057783

Legal business name

MEDICAL CLINIC OF WOODBRIDGE INC

Practice address

12716 Directors Loop
Woodbridge, VA 22192

Phone

(703) 497-1964

Fax

(703) 497-9885

NPI assigned

Sep 13, 2007

Organization subpart

No

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

Authorized official

Name

Gabriel Obiorah Nwufoh, MDNPI 1396759692

Title

President

Phone

(703) 497-1964

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in VA

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Gabriel O Nwufoh, MD

  • Internal Medicine Physician
  • Woodbridge, VA
  • NPI 1396759692
  Medicare reassignment NPD Authorized official
• Chinwe Edith Agbim

  • Family Nurse Practitioner
  • Woodbridge, VA
  • NPI 1831616010
  NPD

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

{
    "created_epoch": "1189641600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1727308800000",
    "number": "1336334275",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1690 OLD BRIDGE RD STE 200",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "221928006",
            "telephone_number": "703-497-1964",
            "fax_number": "703-497-9885"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12716 DIRECTORS LOOP",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "22192",
            "telephone_number": "703-497-1964",
            "fax_number": "703-497-9885"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDICAL CLINIC OF WOODBRIDGE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-13",
        "last_updated": "2024-09-26",
        "certification_date": "2024-09-26",
        "status": "A",
        "authorized_official_last_name": "NWUFOH",
        "authorized_official_first_name": "GABRIEL",
        "authorized_official_middle_name": "OBIORAH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "703-497-1964",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": "0101057783",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "005821037",
            "state": "VA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "gabrielnwufoh@direct.practicefusion.com",
            "affiliation": "N",
            "endpointDescription": "EHR",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "12716 Directors Loop",
            "city": "Woodbridge",
            "state": "VA",
            "country_code": "US",
            "postal_code": "22192",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Sylvia Debronger Mebane-Brooks, NP
• Ana Teresa Mebune
• Medco
• Medease
• Medi Health LLC
• Medical Company
• Medical Company
• Medihub USA LLC
• Mednovations LLC
• Medprime, LLC

• Internal Medicine Physician in Woodbridge, VA
• Providers in Woodbridge, 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 Sep 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.