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NPI Code Detail

MEDICARE: NETA, INC.

MEDICARE: NETA, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084P0804XChild & Adolescent Psychiatry Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10101257801OTHERVAVA LICENSE

General Provider Information

NPI Number : 1134506520
Entity Type Code : Organization
Provider Name (Legal Business Name) : NETA, INC.
Provider Business Mailing Address
First Line : 801 N QUINCY ST STE 601
Second Line :
City : ARLINGTON
State : VA
Zip : 22203-1729
Country : US
Telephone Number : 703-812-4642
Fax Number : 703-812-7926
Provider Business Practice Location Address
First Line : 801 N QUINCY ST STE 601
Second Line :
City : ARLINGTON
State : VA
Zip : 22203-1729
Country : US
Telephone Number : 703-812-4642
Fax Number : 703-812-7926
Authorized Official
Title or Position : PRESIDENT
Name : NEEL VILAS NENE
Credential : MD
Telephone Number : 703-244-6215
Provider Enumeration Date : 05/05/2015
Last Update Date : 10/29/2020

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