Penderbrook Internal Medicine and Wellness, PLLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

0101840408 Issued in VA

Legal business name

PENDERBROOK INTERNAL MEDICINE AND WELLNESS, PLLC

Practice address

4001 Fair Ridge Dr
Suite 206
Fairfax, VA 22033-2917

Phone

(703) 716-5404

Fax

(703) 716-5410

NPI assigned

Dec 8, 2009

Organization subpart

No

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

Authorized official

Name

Dr. Thien Quang Dat Le, M.D.NPI 1538254875

Title

Owner

Phone

(703) 716-5404

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in DC

Enrollment records 1

Practitioners 1

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

• Thienquang Dat Le, M.D.

  • Internal Medicine Physician
  • Fairfax, VA
  • NPI 1538254875

  DC

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1260230400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1317254400000",
    "number": "1972832608",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4001 FAIR RIDGE DR",
            "address_2": "SUITE 206",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220332917",
            "telephone_number": "703-716-5404",
            "fax_number": "703-716-5410"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4001 FAIR RIDGE DR",
            "address_2": "SUITE 206",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220332917",
            "telephone_number": "703-716-5404",
            "fax_number": "703-716-5410"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PENDERBROOK INTERNAL MEDICINE AND WELLNESS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-12-08",
        "last_updated": "2011-09-29",
        "status": "A",
        "authorized_official_last_name": "LE",
        "authorized_official_first_name": "THIEN QUANG",
        "authorized_official_middle_name": "DAT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "703-716-5404",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "VA",
            "license": "0101840408",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lori Fay Pele
• Nicole Alyssa Pellicciotto, MED, ABD
• Pelvic Pro Physical Therapy LLC
• Heidi Pena-Moog, LPTA
• Alejandra Lucia Pena
• Marianne Guy Pendlebury
• Lei Peng, M.D.
• Sarah Penland, LCSW
• Gary Penner
• Narayana Gabriel Pennington

• Internal Medicine Physician in Fairfax, VA
• Providers in Fairfax, 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 29, 2011; 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.