MEDICARE: ARLINGTON OB-GYN, 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	207V00000X	Obstetrics & Gynecology Physician	0101234648	VA

General Provider Information

NPI Number	:	1760489231
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARLINGTON OB-GYN, PC

Provider Business Mailing Address
First Line	:	PO BOX 1400
Second Line	:
City	:	FAIRFAX
State	:	VA
Zip	:	22038-1400
Country	:	US
Telephone Number	:	703-383-9543
Fax Number	:	703-383-9532

Provider Business Practice Location Address
First Line	:	1715 N GEORGE MASON DR
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22205-3662
Country	:	US
Telephone Number	:	703-528-4211
Fax Number	:	703-528-4233

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DEEPALI KOTHARY
Credential	:	M.D.
Telephone Number	:	703-528-4211

Provider Enumeration Date	:	06/30/2005
Last Update Date	:	08/22/2020

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