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General NPI Number Information
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NPI Number | 1366872285
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Entity Type | Organization
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Legal Business Name | SEVA MEDICAL GROUP LLC
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Dates
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Enumeration Date | 11/13/2013
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Last Update Date | 02/26/2014
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Provider Practice Location Address
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Address Line | 24805 PINEBROOK RD SUITE 101
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City | CHANTILLY
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State | VA
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Zip | 20152-4126
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Country | US
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Telephone | 571-367-2261
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Fax |
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Provider Business Mailing Address
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Address Line | 11490 COMMERCE PARK DR SUITE 525
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City | RESTON
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State | VA
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Zip | 20191-1557
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Country | US
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Telephone | 571-367-2261
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. ANIL GUPTA
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Credential |
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Telephone | 832-969-7775
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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 |
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License Number State |
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