Provider Demographics
NPI:1164779682
Name:BENJAMIN I. ENAV, MD, LLC
Entity Type:Organization
Organization Name:BENJAMIN I. ENAV, MD, LLC
Other - Org Name:PEDIATRIC GASTROENTEROLOGY OF NORTHERN VIRGINIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ENAV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:571-314-0444
Mailing Address - Street 1:2700 PROSPERITY AVE
Mailing Address - Street 2:SUITE 260
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4339
Mailing Address - Country:US
Mailing Address - Phone:571-314-0444
Mailing Address - Fax:855-237-3628
Practice Address - Street 1:2700 PROSPERITY AVE
Practice Address - Street 2:SUITE 260
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4339
Practice Address - Country:US
Practice Address - Phone:571-314-0444
Practice Address - Fax:855-237-3628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-14
Last Update Date:2013-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012436802080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric GastroenterologyGroup - Single Specialty