Healthcare Provider Details

I. General information

NPI: 1457450918
Provider Name (Legal Business Name): NOVA ORTHOPEDIC & SPINE CARE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 01/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2028 OPITZ BLVD SUITE B
WOODBRIDGE VA
22191-3306
US

IV. Provider business mailing address

14605 POTOMAC BRANCH DR SUITE 300
WOODBRIDGE VA
22191-3336
US

V. Phone/Fax

Practice location:
  • Phone: 703-490-1112
  • Fax: 703-490-8064
Mailing address:
  • Phone: 703-490-1112
  • Fax: 703-878-8732

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: PAYMAUN M LOTFI
Title or Position: OWNER
Credential: MD
Phone: 703-490-1112