MEDICARE: NOVA ORTHOPEDIC & SPINE CARE, PC

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	174400000X	Specialist

General Provider Information

NPI Number	:	1457450918
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NOVA ORTHOPEDIC & SPINE CARE, PC

Provider Business Mailing Address
First Line	:	14605 POTOMAC BRANCH DR
Second Line	:	SUITE 300
City	:	WOODBRIDGE
State	:	VA
Zip	:	22191-3336
Country	:	US
Telephone Number	:	703-490-1112
Fax Number	:	703-878-8732

Provider Business Practice Location Address
First Line	:	2028 OPITZ BLVD
Second Line	:	SUITE B
City	:	WOODBRIDGE
State	:	VA
Zip	:	22191-3306
Country	:	US
Telephone Number	:	703-490-1112
Fax Number	:	703-490-8064

Authorized Official
Title or Position	:	OWNER
Name	:	PAYMAUN M LOTFI
Credential	:	MD
Telephone Number	:	703-490-1112

Provider Enumeration Date	:	09/21/2006
Last Update Date	:	01/30/2013

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