Healthcare Provider Details

I. General information

NPI: 1679692974
Provider Name (Legal Business Name): NOVA MEDICAL SERVICES,PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 11/03/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4229 LAFAYETTE CENTER DR SUITE 1425
CHANTILLY VA
20151-1261
US

IV. Provider business mailing address

PO BOX 734
CENTREVILLE VA
20122-0734
US

V. Phone/Fax

Practice location:
  • Phone: 703-961-1119
  • Fax: 703-961-1159
Mailing address:
  • Phone: 703-961-1119
  • Fax: 703-961-1159

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number0101237990
License Number StateVA

VIII. Authorized Official

Name: NEERAJA THATHAGARI
Title or Position: OWNER
Credential: M.D
Phone: 703-961-1119