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General NPI Number Information
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NPI Number | 1104342740
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Entity Type | Organization
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Legal Business Name | JVH SURGICAL ASSOCIATES LLC
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Dates
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Enumeration Date | 08/15/2017
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Last Update Date | 10/18/2017
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Provider Practice Location Address
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Address Line | 8118 GOOD LUCK RD
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City | LANHAM
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State | MD
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Zip | 20706-3574
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Country | US
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Telephone | 301-552-8118
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Fax |
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Provider Business Mailing Address
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Address Line | 3100 MAGNOLIA GLN APT 102
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City | FREDERICKSBURG
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State | VA
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Zip | 22401-8902
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Country | US
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Telephone | 808-230-3933
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | JOSEPH CHRISTOPHER LUNA
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Credential | CSFA
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Telephone | 808-230-3933
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number |
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License Number State |
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