Healthcare Provider Details

I. General information

NPI: 1871752329
Provider Name (Legal Business Name): NORTHERN VIRGINIA PELVIC SURGERY ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2008
Last Update Date: 09/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10215 FERNWOOD RD SUITE 300
BETHESDA MD
20817
US

IV. Provider business mailing address

3289 WOODBURN RD SUITE 320
ANNANDALE VA
22003-6800
US

V. Phone/Fax

Practice location:
  • Phone: 703-698-7100
  • Fax: 703-207-9487
Mailing address:
  • Phone: 703-698-7100
  • Fax: 703-207-9487

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: JEFFREY WELGOSS
Title or Position: PHYSICIAN
Credential: MD
Phone: 703-698-7100