=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922613694
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PREMIER HEALTH CONSULTANTS OF NORTHERN VIRGINIA INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/10/2020
-----------------------------------------------------
Last Update Date | 09/10/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 44121 HARRY BYRD HWY STE 250
-----------------------------------------------------
City | ASHBURN
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 20147-5674
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 703-662-3359
-----------------------------------------------------
Fax | 703-997-2627
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 21882 HYDE PARK DR
-----------------------------------------------------
City | ASHBURN
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 20147-6911
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 775-848-8287
-----------------------------------------------------
Fax | 703-997-2627
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | KAVITA NAMJOSHI
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 775-848-8287
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------