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General NPI Number Information
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NPI Number | 1902178817
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Entity Type | Organization
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Legal Business Name | MEDICAL CENTER OF NORTHERN VIRGINIA
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Dates
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Enumeration Date | 02/08/2012
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Last Update Date | 02/08/2012
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Provider Practice Location Address
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Address Line | 450 W BROAD ST SUITE 420
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City | FALLS CHURCH
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State | VA
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Zip | 22046-3340
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Country | US
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Telephone | 703-533-0311
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Fax | 703-533-0312
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Provider Business Mailing Address
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Address Line | 450 W BROAD ST SUITE 420
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City | FALLS CHURCH
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State | VA
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Zip | 22046-3340
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Country | US
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Telephone | 703-533-0311
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Fax | 703-533-0312
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Authorized Official
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Title or Position | PRESIDENT
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Name | BENJAMIN GOKEL DELE
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Credential |
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Telephone | 703-533-0311
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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