Provider Demographics
NPI:1225454291
Name:CHISOVEREIGN PLLC
Entity Type:Organization
Organization Name:CHISOVEREIGN PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:IJEOMA
Authorized Official - Middle Name:N
Authorized Official - Last Name:NNAMANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:703-505-2476
Mailing Address - Street 1:3975 FAIR RIDGE DR
Mailing Address - Street 2:SUITE 150N
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-2911
Mailing Address - Country:US
Mailing Address - Phone:703-246-0011
Mailing Address - Fax:703-246-0012
Practice Address - Street 1:3975 FAIR RIDGE DR
Practice Address - Street 2:SUITE 150N
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-2911
Practice Address - Country:US
Practice Address - Phone:703-246-0011
Practice Address - Fax:703-246-0012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-13
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101246435261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty