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General NPI Number Information
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NPI Number | 1295165298
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Entity Type | Organization
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Legal Business Name | NIMALI FERNANDO MD PLC
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Dates
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Enumeration Date | 11/13/2013
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Last Update Date | 11/13/2013
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Provider Practice Location Address
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Address Line | 10482 GEORGETOWN DR
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City | SPOTSYLVANIA
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State | VA
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Zip | 22553-1748
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Country | US
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Telephone | 540-369-3316
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Fax | 540-369-3317
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Provider Business Mailing Address
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Address Line | 10482 GEORGETOWN DR
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City | SPOTSYLVANIA
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State | VA
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Zip | 22553-1748
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Country | US
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Telephone | 540-369-3316
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Fax | 540-369-3317
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | NIMALI FERNANDO
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Credential | MD
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Telephone | 540-369-3316
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State | VA
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