1699857128 NPI number — VIRGINIA FAMILY MEDICINE, PLLC

Table of content: KATHY YOUNG SHUGAR LCSW (NPI 1982706842)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699857128 NPI number — VIRGINIA FAMILY MEDICINE, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VIRGINIA FAMILY MEDICINE, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699857128
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9401 LEE HIGHWAY
Provider Second Line Business Mailing Address:
SUITE 400
Provider Business Mailing Address City Name:
FAIRFAX
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22031
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-383-4836
Provider Business Mailing Address Fax Number:
703-383-4911

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9401 LEE HWY
Provider Second Line Business Practice Location Address:
SUITE 400
Provider Business Practice Location Address City Name:
FAIRFAX
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22031-1849
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-383-4836
Provider Business Practice Location Address Fax Number:
703-383-4911
Provider Enumeration Date:
10/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MILANI
Authorized Official First Name:
KAVIAN
Authorized Official Middle Name:
S.
Authorized Official Title or Position:
OWNER PRINCIPAL
Authorized Official Telephone Number:
703-560-6268

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  0101057147 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 5633320 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




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