Healthcare Provider Details

I. General information

NPI: 1831805357
Provider Name (Legal Business Name): DVA MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2023
Last Update Date: 01/27/2023
Certification Date: 01/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8714 GEORGIA AVE
SILVER SPRING MD
20910-3601
US

IV. Provider business mailing address

400 ARMY NAVY DR APT 1127
ARLINGTON VA
22202-4758
US

V. Phone/Fax

Practice location:
  • Phone: 301-276-4691
  • Fax: 301-589-2007
Mailing address:
  • Phone: 848-391-9189
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DARE AJIBADE
Title or Position: OWNER
Credential: MD
Phone: 848-391-9189