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General NPI Number Information
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NPI Number | 1043403504
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Entity Type | Organization
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Legal Business Name | NOVA PAIN CLINIC INC
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Dates
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Enumeration Date | 08/19/2007
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Last Update Date | 06/07/2010
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Provider Practice Location Address
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Address Line | 6151 FULLER CT
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City | ALEXANDRIA
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State | VA
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Zip | 22310-2541
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Country | US
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Telephone | 703-347-9770
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Fax | 703-347-9251
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Provider Business Mailing Address
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Address Line | 6081 DEER RIDGE TRL
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City | SPRINGFIELD
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State | VA
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Zip | 22150-1046
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Country | US
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Telephone | 703-922-0415
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RAKESH R BHATT
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Credential | MD
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Telephone | 703-922-0415
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | 0101230999
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License Number State | VA
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