MEDICARE: NOVA OCCUPATIONAL HEALTH INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	0101048836	VA
2	2083X0100X	Occupational Medicine Physician	0101057543	VA

General Provider Information

NPI Number	:	1679836746
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NOVA OCCUPATIONAL HEALTH INC

Provider Business Mailing Address
First Line	:	8714 SUDLEY RD
Second Line	:
City	:	MANASSAS
State	:	VA
Zip	:	20110-4405
Country	:	US
Telephone Number	:	703-468-0150
Fax Number	:	703-361-0346

Provider Business Practice Location Address
First Line	:	8714 SUDLEY RD
Second Line	:
City	:	MANASSAS
State	:	VA
Zip	:	20110-4405
Country	:	US
Telephone Number	:	703-468-0150
Fax Number	:	703-361-0346

Authorized Official
Title or Position	:	ACCOUNT MANAGER
Name	:	MADHUSUDAN PANTHI
Credential	:
Telephone Number	:	703-468-0150

Provider Enumeration Date	:	06/22/2012
Last Update Date	:	06/22/2012

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Directions to “NOVA OCCUPATIONAL HEALTH INC ” Practice Location

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