Healthcare Provider Details

I. General information

NPI: 1962438119
Provider Name (Legal Business Name): VIRGINIA GYNECOLOGISTS, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 MAPLE AVE W
VIENNA VA
22180-4240
US

IV. Provider business mailing address

410 MAPLE AVE W
VIENNA VA
22180-4240
US

V. Phone/Fax

Practice location:
  • Phone: 703-281-5007
  • Fax: 703-281-3491
Mailing address:
  • Phone: 703-281-5007
  • Fax: 703-281-3491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: REBECA B GRIMM
Title or Position: OFFICE MANAGER
Credential:
Phone: 703-281-5007