MEDICARE: NORTHERN VIRGINIA SURGICAL GROUP, 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	208C00000X	Colon & Rectal Surgery Physician		VA

General Provider Information

NPI Number	:	1710918438
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHERN VIRGINIA SURGICAL GROUP, PC

Provider Business Mailing Address
First Line	:	8316 ARLINGTON BLVD.
Second Line	:	SUITE 630
City	:	FAIRFAX
State	:	VA
Zip	:	22031-5216
Country	:	US
Telephone Number	:	703-560-7788
Fax Number	:	703-573-5629

Provider Business Practice Location Address
First Line	:	8316 ARLINGTON BLVD.
Second Line	:	SUITE 630
City	:	FAIRFAX
State	:	VA
Zip	:	22031-5216
Country	:	US
Telephone Number	:	703-560-7788
Fax Number	:	703-573-5629

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	WILLIAM SEID
Credential	:	M.D.
Telephone Number	:	703-560-7788

Provider Enumeration Date	:	07/05/2006
Last Update Date	:	03/18/2009

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