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General NPI Number Information
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NPI Number | 1518317965
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Entity Type | Organization
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Legal Business Name | TYSON'S PAIN CENTER, P.C.
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Dates
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Enumeration Date | 06/16/2016
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Last Update Date | 06/16/2016
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Provider Practice Location Address
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Address Line | 8133 LEESBURG PIKE SUITE 305
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City | VIENNA
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State | VA
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Zip | 22182-2751
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Country | US
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Telephone | 703-897-1300
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Fax | 703-897-1301
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Provider Business Mailing Address
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Address Line | 8133 LEESBURG PIKE SUITE 305
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City | VIENNA
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State | VA
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Zip | 22182-2706
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Country | US
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Telephone | 703-897-1300
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Fax | 703-897-1301
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ALI HASSAN NAGIA
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Credential | M.D.
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Telephone | 703-897-1300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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License Number | 0101057229
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License Number State | VA
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