MEDICARE: NOVA MEDICAL SERVICES,PLLC

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	261Q00000X	Clinic/Center	0101237990	VA

General Provider Information

NPI Number	:	1679692974
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NOVA MEDICAL SERVICES,PLLC

Provider Business Mailing Address
First Line	:	PO BOX 734
Second Line	:
City	:	CENTREVILLE
State	:	VA
Zip	:	20122-0734
Country	:	US
Telephone Number	:	703-961-1119
Fax Number	:	703-961-1159

Provider Business Practice Location Address
First Line	:	4229 LAFAYETTE CENTER DR
Second Line	:	SUITE 1425
City	:	CHANTILLY
State	:	VA
Zip	:	20151-1261
Country	:	US
Telephone Number	:	703-961-1119
Fax Number	:	703-961-1159

Authorized Official
Title or Position	:	OWNER
Name	:	NEERAJA THATHAGARI
Credential	:	M.D
Telephone Number	:	703-961-1119

Provider Enumeration Date	:	03/28/2007
Last Update Date	:	11/03/2007

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