Healthcare Provider Details

I. General information

NPI: 1952983298
Provider Name (Legal Business Name): VIRGINIA PAIN AND ADDICTION CONSULTANTS, PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2021
Last Update Date: 04/26/2021
Certification Date: 04/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9309 CENTER ST STE 101
MANASSAS VA
20110-5599
US

IV. Provider business mailing address

9309 CENTER ST STE 101
MANASSAS VA
20110-5599
US

V. Phone/Fax

Practice location:
  • Phone: 703-828-6475
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: ASH DIWAN
Title or Position: OWNER
Credential: MD
Phone: 703-828-6475