Healthcare Provider Details

I. General information

NPI: 1073369468
Provider Name (Legal Business Name): VIRGINIA SURGERY GROUP PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2024
Last Update Date: 04/25/2024
Certification Date: 04/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 TOWN CENTER PKWY STE 310
RESTON VA
20190-3300
US

IV. Provider business mailing address

8284 SPRING LEAF CT
VIENNA VA
22182-6027
US

V. Phone/Fax

Practice location:
  • Phone: 832-494-7701
  • Fax:
Mailing address:
  • Phone: 832-494-7701
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MOHAMMED BAYASI
Title or Position: PHYSICIAN
Credential: MD
Phone: 832-494-7701