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General NPI Number Information
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NPI Number | 1679692974
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Entity Type | Organization
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Legal Business Name | NOVA MEDICAL SERVICES,PLLC
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Dates
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Enumeration Date | 03/28/2007
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Last Update Date | 11/03/2007
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Provider Practice Location Address
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Address Line | 4229 LAFAYETTE CENTER DR SUITE 1425
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City | CHANTILLY
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State | VA
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Zip | 20151-1261
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Country | US
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Telephone | 703-961-1119
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Fax | 703-961-1159
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Provider Business Mailing Address
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Address Line | PO BOX 734
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City | CENTREVILLE
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State | VA
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Zip | 20122-0734
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Country | US
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Telephone | 703-961-1119
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Fax | 703-961-1159
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Authorized Official
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Title or Position | OWNER
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Name | NEERAJA THATHAGARI
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Credential | M.D
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Telephone | 703-961-1119
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 0101237990
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License Number State | VA
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