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General NPI Number Information
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NPI Number | 1073653515
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Entity Type | Organization
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Legal Business Name | NORTHERN VIRGINIA PSYCHIATRIC GROUP PC
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Dates
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Enumeration Date | 02/07/2007
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Last Update Date | 11/10/2011
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Provider Practice Location Address
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Address Line | 7620 CARROLL AVE SUITE 200
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City | TAKOMA PARK
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State | MD
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Zip | 20912-6387
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Country | US
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Telephone | 703-698-5220
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Fax | 703-573-2351
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Provider Business Mailing Address
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Address Line | 8500 EXECUTIVE PARK AVE SUITE 200
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City | FAIRFAX
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State | VA
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Zip | 22031-2225
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Country | US
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Telephone | 703-698-5220
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Fax | 703-573-2351
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | DR. RICHARD BAITHER
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Credential | PHD
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Telephone | 703-698-5220
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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