Provider Demographics
NPI:1144374406
Name:VIRGINIA PULMONARY ASSOCIATES, P.C.
Entity type:Organization
Organization Name:VIRGINIA PULMONARY ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALA
Authorized Official - Middle Name:S
Authorized Official - Last Name:MORTAZAVI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-497-0319
Mailing Address - Street 1:2024 OPITZ BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-3388
Mailing Address - Country:US
Mailing Address - Phone:703-497-0319
Mailing Address - Fax:703-497-0421
Practice Address - Street 1:2024 OPITZ BLVD STE C
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-3388
Practice Address - Country:US
Practice Address - Phone:703-497-0319
Practice Address - Fax:703-497-0421
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VIRGINIA PULMONARY ASSOCIATES, P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-23
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC05895Medicare PIN