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General NPI Number Information
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NPI Number | 1467680611
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Entity Type | Organization
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Legal Business Name | NORTHERN VIRGINIA ENDOSCOPY CENTER
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Dates
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Enumeration Date | 06/26/2009
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Last Update Date | 03/18/2013
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Provider Practice Location Address
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Address Line | 2280 OPITZ BLVD SUITE 200
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City | WOODBRIDGE
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State | VA
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Zip | 22191-3362
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Country | US
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Telephone | 703-580-7433
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Fax | 703-580-7437
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Provider Business Mailing Address
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Address Line | 2280 OPITZ BLVD SUITE 200
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City | WOODBRIDGE
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State | VA
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Zip | 22191-3362
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Country | US
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Telephone | 703-580-7433
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Fax | 703-580-7437
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | HOUSHANG MAKIPOUR
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Credential | MD
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Telephone | 703-580-7433
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QE0800X
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Taxonomy Name | Endoscopy Clinic/Center
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License Number |
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License Number State |
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