Provider Demographics
NPI:1245381789
Name:MS CENTER OF GREATER WASHINGTON PC
Entity Type:Organization
Organization Name:MS CENTER OF GREATER WASHINGTON PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MEGHAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:FREDERICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-226-4000
Mailing Address - Street 1:8320 OLD COURTHOUSE RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3831
Mailing Address - Country:US
Mailing Address - Phone:703-226-4000
Mailing Address - Fax:703-226-4010
Practice Address - Street 1:8320 OLD COURTHOUSE RD
Practice Address - Street 2:SUITE 400
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-3831
Practice Address - Country:US
Practice Address - Phone:703-226-4000
Practice Address - Fax:703-226-4010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101056335261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAG02530Medicare PIN