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General NPI Number Information
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NPI Number | 1841255866
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Entity Type | Individual
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Provider Name | NINO MARIO DOBROVIC M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/20/2006
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Last Update Date | 12/15/2020
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Provider Practice Location Address
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Address Line | 46400 BENEDICT DR STE 1
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City | STERLING
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State | VA
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Zip | 20164-6604
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Country | US
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Telephone | 703-444-2592
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Fax | 703-444-2593
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Provider Business Mailing Address
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Address Line | 46400 BENEDICT DR STE 1
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City | STERLING
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State | VA
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Zip | 20164-6604
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Country | US
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Telephone | 703-444-2592
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Fax | 703-444-2593
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 0101051921
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | 0101051921
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 0101051921
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License Number State | VA
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Taxonomy #4
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | 0101051921
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License Number State | VA
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