Provider Demographics
NPI:1144415480
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 - MATERNAL FETAL MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MS
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 1:1715 N GEORGE MASON DR
Mailing Address - Street 2:SUITE 409
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22205-3609
Mailing Address - Country:US
Mailing Address - Phone:703-558-6077
Mailing Address - Fax:703-558-6015
Practice Address - Street 1:1635 N GEORGE MASON DR
Practice Address - Street 2:SUITE 190
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22205-3601
Practice Address - Country:US
Practice Address - Phone:703-558-6077
Practice Address - Fax:703-558-6015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-10
Last Update Date:2015-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric MedicineGroup - Multi-Specialty
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal MedicineGroup - Multi-Specialty
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
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