Healthcare Provider Details

I. General information

NPI: 1255450722
Provider Name (Legal Business Name): CHILDREN'S MEDICAL ASSOCIATES OF NORTHERN VIRGINIA, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 07/21/2025
Certification Date: 07/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6303 LITTLE RIVER TPKE STE 300
ALEXANDRIA VA
22312-5045
US

IV. Provider business mailing address

6303 LITTLE RIVER TPKE STE 300
ALEXANDRIA VA
22312-5045
US

V. Phone/Fax

Practice location:
  • Phone: 703-914-8989
  • Fax:
Mailing address:
  • Phone: 703-914-8989
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. GHASSAN ATIYEH
Title or Position: PARTNER
Credential: MD
Phone: 703-914-8989