Millennium Medical Center LLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

0101242652 Issued in VA

Legal business name

MILLENNIUM MEDICAL CENTER LLC

Practice address

3606 Forest Dr
Alexandria, VA 22302-1005

Phone

(703) 820-7520

NPI assigned

Oct 6, 2009

Organization subpart

No

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

Authorized official

Name

Shayma Al-Mudhafar, MDNPI 1538340708

Title

President

Phone

(703) 820-7520

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in DC

Enrollment records 1

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/16257/brand/1/csg/1/fhir/r4

Practitioners 3

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

• Shayma J Al-Mudhafar, M.D.

  • Internal Medicine Physician
  • Falls Church, VA
  • NPI 1538340708

  DC

  Medicare reassignment NPD Authorized official
• Gayle Debra Masri-Fridling, M.D.

  • Dermatology Physician
  • Vienna, VA
  • NPI 1336267681
  NPD (past)
• Seher Rakin, PA-C

  • Physician Assistant
  • Alexandria, VA
  • NPI 1154860724
  NPD (past)

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

{
    "created_epoch": "1254787200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1254787200000",
    "number": "1689909897",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3606 FOREST DR",
            "city": "ALEXANDRIA",
            "state": "VA",
            "postal_code": "223021005",
            "telephone_number": "703-820-7520"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3606 FOREST DR",
            "city": "ALEXANDRIA",
            "state": "VA",
            "postal_code": "223021005",
            "telephone_number": "703-820-7520"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MILLENNIUM MEDICAL CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-10-06",
        "last_updated": "2009-10-06",
        "status": "A",
        "authorized_official_last_name": "AL-MUDHAFAR",
        "authorized_official_first_name": "SHAYMA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "703-820-7520",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "VA",
            "license": "0101242652",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Miles Massage Inc.
• Military Professional Resources, Inc
• Milky Weigh Lactation Services, LLC
• Millennium Home Care LLC
• Millennium Home Health Care LLC
• Millennium Total Health (Millennium Total Health & Fitness, LLC)
• Millennium Total Health and Fitness (Millenium Total Health and Fitness)
• Millennium Total Health, LLC (Millennium Total Health& Fitness, LLC)
• Miller DDS of Alexandria, PC (Mount Vernon Dental Smiles)
• Azaria Miller

• Internal Medicine Physician in Alexandria, VA
• Providers in Alexandria, 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 Oct 6, 2009; 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.