Provider Demographics
NPI:1447540604
Name:WALK IN MEDICAL CENTER P.C.
Entity type:Organization
Organization Name:WALK IN MEDICAL CENTER P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:SOAIDY
Authorized Official - Middle Name:
Authorized Official - Last Name:SOOKLALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-668-0222
Mailing Address - Street 1:201 ELDEN ST STE 101
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-4812
Mailing Address - Country:US
Mailing Address - Phone:703-668-0222
Mailing Address - Fax:703-668-0224
Practice Address - Street 1:201 ELDEN ST STE 101
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-4812
Practice Address - Country:US
Practice Address - Phone:703-668-0222
Practice Address - Fax:703-668-0224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-08
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110003515363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty