Provider Demographics
NPI:1154487007
Name:ENDOCRINE AND DIABETES CENTER P.C.
Entity Type:Organization
Organization Name:ENDOCRINE AND DIABETES CENTER P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALI
Authorized Official - Middle Name:M
Authorized Official - Last Name:SAFA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-938-8885
Mailing Address - Street 1:301 MAPLE AVE W
Mailing Address - Street 2:SUITE 120
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22180-4301
Mailing Address - Country:US
Mailing Address - Phone:703-938-8885
Mailing Address - Fax:703-242-2437
Practice Address - Street 1:301 MAPLE AVE W
Practice Address - Street 2:SUITE 120
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22180-4301
Practice Address - Country:US
Practice Address - Phone:703-938-8885
Practice Address - Fax:703-242-2437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2013-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA101040528207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C62504Medicare UPIN
VAG01228Medicare ID - Type Unspecified
VAC08745Medicare ID - Type Unspecified