Healthcare Provider Details

I. General information

NPI: 1548351802
Provider Name (Legal Business Name): OB-GYN ASSOCIATES OF N VA LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 06/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6355 WALKER LN SUITE 408
ALEXANDRIA VA
22310-3245
US

IV. Provider business mailing address

6355 WALKER LN SUITE 408
ALEXANDRIA VA
22310-3245
US

V. Phone/Fax

Practice location:
  • Phone: 703-719-5901
  • Fax: 703-719-9629
Mailing address:
  • Phone: 703-719-5901
  • Fax: 703-719-9629

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. DARIA G LEPISKO
Title or Position: ADMINISTRATOR
Credential:
Phone: 703-719-0382