Provider Demographics
NPI:1235211723
Name:NORTHERN VIRGINIA WELLNESS CENTER
Entity Type:Organization
Organization Name:NORTHERN VIRGINIA WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DEEPAK
Authorized Official - Middle Name:NMN
Authorized Official - Last Name:GOEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-933-1600
Mailing Address - Street 1:5201 LEESBURG PIKE STE 103
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22041-3200
Mailing Address - Country:US
Mailing Address - Phone:703-933-1600
Mailing Address - Fax:703-933-2502
Practice Address - Street 1:5201 LEESBURG PIKE, STE 103
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22041-3203
Practice Address - Country:US
Practice Address - Phone:703-933-1600
Practice Address - Fax:703-933-2502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QS1200X
VA0206009251332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA4885760001Medicare NSC