Healthcare Provider Details

I. General information

NPI: 1245381789
Provider Name (Legal Business Name): MS CENTER OF GREATER WASHINGTON PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 12/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8320 OLD COURTHOUSE RD SUITE 400
VIENNA VA
22182-3831
US

IV. Provider business mailing address

8320 OLD COURTHOUSE RD SUITE 400
VIENNA VA
22182-3831
US

V. Phone/Fax

Practice location:
  • Phone: 703-226-4000
  • Fax: 703-226-4010
Mailing address:
  • Phone: 703-226-4000
  • Fax: 703-226-4010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number0101056335
License Number StateVA

VIII. Authorized Official

Name: MS. MEGHAN M FREDERICK
Title or Position: OFFICE MANAGER
Credential:
Phone: 703-226-4000