Healthcare Provider Details

I. General information

NPI: 1932658929
Provider Name (Legal Business Name): VIRGINIA NEURO CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2016
Last Update Date: 10/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7616 SEABROOK LN
SPRINGFIELD VA
22153-2163
US

IV. Provider business mailing address

7616 SEABROOK LN
SPRINGFIELD VA
22153-2163
US

V. Phone/Fax

Practice location:
  • Phone: 703-879-2756
  • Fax:
Mailing address:
  • Phone: 703-879-2756
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number0101239509
License Number StateVA

VIII. Authorized Official

Name: SADIA KHAN
Title or Position: NEUROLOGIST
Credential: MD
Phone: 703-879-2756