Provider Demographics
NPI:1013379874
Name:NOVA RECONSTRUCTIVE AND COSMETIC SURGERY PLLC
Entity Type:Organization
Organization Name:NOVA RECONSTRUCTIVE AND COSMETIC SURGERY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MARWAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KHALIFEH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-486-2261
Mailing Address - Street 1:8180 GREENSBORO DR
Mailing Address - Street 2:#1015
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102-3888
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8180 GREENSBORO DR
Practice Address - Street 2:#1015
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22102-3888
Practice Address - Country:US
Practice Address - Phone:703-543-9252
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-22
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101240322174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty