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General NPI Number Information
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NPI Number | 1225454291
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Entity Type | Organization
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Legal Business Name | CHISOVEREIGN PLLC
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Dates
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Enumeration Date | 03/13/2014
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Last Update Date | 03/13/2014
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Provider Practice Location Address
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Address Line | 3975 FAIR RIDGE DR SUITE 150N
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City | FAIRFAX
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State | VA
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Zip | 22033-2911
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Country | US
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Telephone | 703-246-0011
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Fax | 703-246-0012
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Provider Business Mailing Address
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Address Line | 3975 FAIR RIDGE DR SUITE 150N
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City | FAIRFAX
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State | VA
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Zip | 22033-2911
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Country | US
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Telephone | 703-246-0011
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Fax | 703-246-0012
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. IJEOMA N NNAMANI
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Credential | MD, PHD
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Telephone | 703-505-2476
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 0101246435
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License Number State | VA
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