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General NPI Number Information
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NPI Number | 1184055501
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Entity Type | Organization
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Legal Business Name | NOVA SURGICARE
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Dates
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Enumeration Date | 12/11/2013
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Last Update Date | 12/11/2013
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Provider Practice Location Address
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Address Line | 8201 GREENSBORO DR SUITE 601
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City | MC LEAN
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State | VA
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Zip | 22102-3810
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Country | US
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Telephone | 703-288-4495
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Fax | 703-288-4497
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Provider Business Mailing Address
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Address Line | 8201 GREENSBORO DR SUITE 601
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City | MC LEAN
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State | VA
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Zip | 22102-3810
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Country | US
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Telephone | 703-288-4495
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Fax | 703-288-4497
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | SANAZ HAMRAH
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Credential |
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Telephone | 703-288-4495
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 0438000250
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License Number State | VA
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