Healthcare Provider Details

I. General information

NPI: 1669923967
Provider Name (Legal Business Name): NORTHERN VIRGINIA COMMUNITY HOSPITAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2016
Last Update Date: 03/21/2023
Certification Date: 03/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24440 STONE SPRINGS BLVD
DULLES VA
20166-2247
US

IV. Provider business mailing address

7300 BEAUFONT SPRINGS DR BUILDING VIII, SUITE 101
NORTH CHESTERFIELD VA
23225-5551
US

V. Phone/Fax

Practice location:
  • Phone: 703-689-9000
  • Fax: 703-689-0840
Mailing address:
  • Phone: 804-228-4901
  • Fax: 804-477-1146

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER J. LANDRY
Title or Position: CFO
Credential:
Phone: 804-289-4587