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General NPI Number Information
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NPI Number | 1982871935
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Entity Type | Organization
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Legal Business Name | NORTHERN VIRGINIA SURGERY CENTER LLC
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Dates
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Enumeration Date | 05/09/2008
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Last Update Date | 03/13/2024
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Provider Practice Location Address
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Address Line | 3620 JOSEPH SIEWICK DR STE 202
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City | FAIRFAX
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State | VA
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Zip | 22033-1758
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Country | US
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Telephone | 703-766-6960
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Fax | 703-766-6980
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Provider Business Mailing Address
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Address Line | 3620JOSEPH SIEWICK DRIVE SUITE 202
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City | FAIRFAX
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State | VA
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Zip | 22033
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Country | US
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Telephone | 703-766-6960
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Fax | 703-766-6980
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Authorized Official
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Title or Position | AR & OPERATIONS MANAGER
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Name | DARASINH PHOUMMITHONE MAYARD
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Credential |
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Telephone | 703-395-6410
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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