Healthcare Provider Details

I. General information

NPI: 1437516200
Provider Name (Legal Business Name): VIRGINIA HOSPITAL CENTER PHYSICIAN GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2016
Last Update Date: 01/19/2026
Certification Date: 01/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3440 S JEFFERSON ST
FALLS CHURCH VA
22041-3145
US

IV. Provider business mailing address

3601 EISENHOWER AVE STE 220 ATTN MANAGED CARE CREDENTIALING TEAM
ALEXANDRIA VA
22304-6457
US

V. Phone/Fax

Practice location:
  • Phone: 703-717-7100
  • Fax: 703-940-3433
Mailing address:
  • Phone: 703-717-7100
  • Fax: 703-717-4082

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: BRENDA BABBITT
Title or Position: SYS. AVP, MANAGED CARE AND STRATEGI
Credential:
Phone: 703-558-5590