Healthcare Provider Details

I. General information

NPI: 1629361845
Provider Name (Legal Business Name): VIRGINIA HOSPITAL CENTER PHYSICIAN GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2011
Last Update Date: 12/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1715 N GEORGE MASON DR SUITE 305
ARLINGTON VA
22205-3609
US

IV. Provider business mailing address

1715 N GEORGE MASON DR SUITE 409
ARLINGTON VA
22205-3609
US

V. Phone/Fax

Practice location:
  • Phone: 703-717-7851
  • Fax: 703-717-7852
Mailing address:
  • Phone: 703-717-7851
  • Fax: 703-717-7852

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. ROBIN DEPAOLI
Title or Position: CFO
Credential:
Phone: 703-558-6104