1245556778 NPI number — NORTH EASTERN VIRGINIA MEDICAL, PLLC

Table of content: (NPI 1245556778)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245556778 NPI number — NORTH EASTERN VIRGINIA MEDICAL, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH EASTERN VIRGINIA MEDICAL, 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:
1245556778
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/08/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2122 MCCONVEY PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FALLS CHURCH
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22043-3068
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-303-2806
Provider Business Mailing Address Fax Number:
703-532-1615

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4660 KENMORE AVE
Provider Second Line Business Practice Location Address:
SUITE 600
Provider Business Practice Location Address City Name:
ALEXANDRIA
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22304-1313
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-303-2806
Provider Business Practice Location Address Fax Number:
703-532-1615
Provider Enumeration Date:
04/08/2010

Additional Information

Authorized Official

Authorized Official Last Name:
YASIN
Authorized Official First Name:
SAHBA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/OWNDER
Authorized Official Telephone Number:
703-303-2806

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  0101245174 , 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: 1568432987 . This is a "PROVIDER INDIVIDUAL NPI" identifier . This identifiers is of the category "OTHER".




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