Healthcare Provider Details

I. General information

NPI: 1679544456
Provider Name (Legal Business Name): NORTHERN VIRGINIA GYNECOLOGISTS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6355 WALKER LN SUITE 508
ALEXANDRIA VA
22310-3245
US

IV. Provider business mailing address

6355 WALKER LN SUITE 508
ALEXANDRIA VA
22310-3245
US

V. Phone/Fax

Practice location:
  • Phone: 703-971-7633
  • Fax: 703-971-2219
Mailing address:
  • Phone: 703-971-7633
  • Fax: 703-971-2219

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: MS. MERRY MOLINARI
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 703-971-7633