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General NPI Number Information
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NPI Number | 1124289699
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Entity Type | Organization
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Legal Business Name | NOVA GYNECOLOGY ASSOCIATES LLC
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Dates
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Enumeration Date | 06/18/2008
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Last Update Date | 07/11/2013
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Provider Practice Location Address
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Address Line | 10400 EATON PL STE 515
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City | FAIRFAX
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State | VA
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Zip | 22030-2234
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Country | US
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Telephone | 703-691-4141
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Fax | 703-783-0084
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Provider Business Mailing Address
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Address Line | 8642 RESECA LN
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City | SPRINGFIELD
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State | VA
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Zip | 22152-1411
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Country | US
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Telephone | 703-249-9079
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Fax | 703-249-5186
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | EVELYN KIM
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Credential |
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Telephone | 703-249-9079
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 0101032425
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License Number State | VA
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