Provider Demographics
NPI:1689841850
Name:SUNRISE FAMILY MEDICAL CENTER
Entity type:Organization
Organization Name:SUNRISE FAMILY MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:AHMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:BARAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-476-9300
Mailing Address - Street 1:12359 SUNRISE VALLEY DR STE 200
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20191-3493
Mailing Address - Country:US
Mailing Address - Phone:703-476-9300
Mailing Address - Fax:703-476-9304
Practice Address - Street 1:12359 SUNRISE VALLEY DR STE 200
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20191-3493
Practice Address - Country:US
Practice Address - Phone:703-476-9300
Practice Address - Fax:703-476-9304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-15
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VABB7494901261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA106459OtherANTHEM
VA4127655OtherCIGNA
J738-0001OtherCAREFIRST
5763643OtherAETNA
VA1999094OtherFIRST HEALTH
VAG01498OtherMEDICARE
VA010044481Medicaid
VA297400OtherAMERIGROUP
VAG78378Medicare UPIN