1265987036 NPI number — NORTHERN VIRGINIA PELVIC SURGERY ASSOCIATES, PC

Table of content: (NPI 1265987036)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265987036 NPI number — NORTHERN VIRGINIA PELVIC SURGERY ASSOCIATES, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHERN VIRGINIA PELVIC SURGERY ASSOCIATES, PC
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:
6
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:
1265987036
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/04/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8081 INNOVATION PARK DR STE 775
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAIRFAX
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22031-4867
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
571-308-1830
Provider Business Mailing Address Fax Number:
571-308-1843

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
44055 RIVERSIDE PARKWAY
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
LEESBURG
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
20176-5179
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
571-308-1843
Provider Business Practice Location Address Fax Number:
571-308-1843
Provider Enumeration Date:
08/22/2016

Additional Information

Authorized Official

Authorized Official Last Name:
BICHER
Authorized Official First Name:
ANNETTE
Authorized Official Middle Name:
Authorized Official Title or Position:
PHYSICIAN/PRESIDENT
Authorized Official Telephone Number:
571-308-1830

Provider Taxonomy Codes

  • Taxonomy code: 207VG0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207VX0201X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2014107550 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 616754 . This is a "MEDICARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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