Provider Demographics
NPI:1003228917
Name:VIRGINIA HOSPITAL CENTER PHYSICIAN GROUP LLC
Entity Type:Organization
Organization Name:VIRGINIA HOSPITAL CENTER PHYSICIAN GROUP LLC
Other - Org Name:VIRGINIA HOSPITAL CENTER PHYSICIAN GROUP - PODIATRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:DEPAOLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-558-6104
Mailing Address - Street 1:1600 N BEAUREGARD ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22311-1704
Mailing Address - Country:US
Mailing Address - Phone:703-940-3810
Mailing Address - Fax:703-940-3811
Practice Address - Street 1:1600 N BEAUREGARD ST
Practice Address - Street 2:SUITE 300
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22311-1704
Practice Address - Country:US
Practice Address - Phone:703-940-3810
Practice Address - Fax:703-940-3811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-27
Last Update Date:2015-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty