Provider Demographics
NPI:1164638490
Name:NORTHERN VIRGINIA PELVIC SURGERY ASSOCIATES, PC
Entity Type:Organization
Organization Name:NORTHERN VIRGINIA PELVIC SURGERY ASSOCIATES, PC
Other - Org Name:MID ATLANTIC GYNECOLOGIC ONCOLOGY AND PELVIC SURGERY ASSO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:BICHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:571-308-1830
Mailing Address - Street 1:8081 INNOVATION PARK DR STE 775
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4867
Mailing Address - Country:US
Mailing Address - Phone:571-308-1830
Mailing Address - Fax:571-308-1843
Practice Address - Street 1:8081 INNOVATION PARK DR STE 775
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4867
Practice Address - Country:US
Practice Address - Phone:571-308-1830
Practice Address - Fax:571-308-1843
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-15
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic OncologyGroup - Multi-Specialty
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA2014107550Medicaid