MEDICARE: CHILDREN'S MEDICAL ASSOCIATES OF NORTHERN VIRGINIA, P.C.

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
1	363LP0200X	Pediatric Nurse Practitioner
2	208000000X	Pediatrics Physician

General Provider Information

NPI Number	:	1255450722
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHILDREN'S MEDICAL ASSOCIATES OF NORTHERN VIRGINIA, P.C.

Provider Business Mailing Address
First Line	:	6303 LITTLE RIVER TPKE STE 300
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22312-5045
Country	:	US
Telephone Number	:	703-914-8989
Fax Number	:

Provider Business Practice Location Address
First Line	:	6303 LITTLE RIVER TPKE STE 300
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22312-5045
Country	:	US
Telephone Number	:	703-914-8989
Fax Number	:

Authorized Official
Title or Position	:	PARTNER
Name	:	DR. GHASSAN ATIYEH
Credential	:	MD
Telephone Number	:	703-914-8989

Provider Enumeration Date	:	03/28/2007
Last Update Date	:	07/21/2025

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