Healthcare Provider Details

I. General information

NPI: 1811800907
Provider Name (Legal Business Name): NOVA INNOVATIVE GASTROENTEROLOGY, PLCC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24430 STONE SPRINGS BLVD STE 250
STERLING VA
20166-2268
US

IV. Provider business mailing address

24430 STONE SPRINGS BLVD STE 250
STERLING VA
20166-2268
US

V. Phone/Fax

Practice location:
  • Phone: 206-832-7770
  • Fax:
Mailing address:
  • Phone: 206-832-7770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: TOKUNBO AJAYI
Title or Position: PHYSICIAN
Credential: MD
Phone: 206-832-7770