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General NPI Number Information
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NPI Number | 1811133218
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Entity Type | Organization
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Legal Business Name | DE NOVA CLINIC PC.
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Dates
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Enumeration Date | 01/06/2009
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Last Update Date | 01/06/2009
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Provider Practice Location Address
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Address Line | 6400 ARLINGTON BLVD SUITE 940
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City | FALLS CHURCH
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State | VA
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Zip | 22042-2325
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Country | US
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Telephone | 703-858-9494
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 4495
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City | FALLS CHURCH
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State | VA
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Zip | 22044-0495
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Country | US
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Telephone | 703-858-9494
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | MAHER A HUTTAM
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Credential | M.D.
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Telephone | 703-858-9494
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 0101241929
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License Number State | VA
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