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General NPI Number Information
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NPI Number | 1184292963
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Entity Type | Organization
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Legal Business Name | OBGYNNOVA PLLC
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Dates
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Enumeration Date | 06/16/2021
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Last Update Date | 06/16/2021
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Provider Practice Location Address
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Address Line | 6355 WALKER LN STE 408
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City | ALEXANDRIA
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State | VA
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Zip | 22310-3250
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Country | US
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Telephone | 703-719-5901
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Fax | 703-719-9628
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Provider Business Mailing Address
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Address Line | 6355 WALKER LN STE 408
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City | ALEXANDRIA
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State | VA
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Zip | 22310-3250
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Country | US
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Telephone | 703-719-5901
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Fax | 703-719-9628
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Authorized Official
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Title or Position | PHYSICIAN
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Name | TINA PHAM
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Credential | MD
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Telephone | 703-719-5901
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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