Healthcare Provider Details

I. General information

NPI: 1972843910
Provider Name (Legal Business Name): PINNACLE SURGICAL GROUP, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2013
Last Update Date: 02/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2235 CEDAR LN SUITE 101
VIENNA VA
22182-5202
US

IV. Provider business mailing address

2235 CEDAR LN SUITE 101
VIENNA VA
22182-5202
US

V. Phone/Fax

Practice location:
  • Phone: 703-778-6000
  • Fax: 703-778-6005
Mailing address:
  • Phone: 703-778-6000
  • Fax: 703-778-6005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number0101251675
License Number StateVA

VIII. Authorized Official

Name: NICHO STEVEN TAPAZOGLOU
Title or Position: CEO
Credential: M.D.
Phone: 312-282-7414