Healthcare Provider Details

I. General information

NPI: 1346514007
Provider Name (Legal Business Name): MATERNAL FETAL MEDICINE ASSOCIATES OF NORTHERN VIRGINIA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2012
Last Update Date: 02/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4001 FAIR RIDGE DR SUITE 304
FAIRFAX VA
22033-2917
US

IV. Provider business mailing address

4001 FAIR RIDGE DR SUITE 304
FAIRFAX VA
22033-2917
US

V. Phone/Fax

Practice location:
  • Phone: 703-359-2466
  • Fax: 703-359-1443
Mailing address:
  • Phone: 703-359-2466
  • Fax: 703-359-1443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number
License Number StateVA

VIII. Authorized Official

Name: DR. NISHA ANNE VYAS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 703-359-2466