Provider Demographics
NPI:1245556778
Name:NORTH EASTERN VIRGINIA MEDICAL, PLLC
Entity Type:Organization
Organization Name:NORTH EASTERN VIRGINIA MEDICAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNDER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAHBA
Authorized Official - Middle Name:
Authorized Official - Last Name:YASIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-303-2806
Mailing Address - Street 1:2122 MCCONVEY PL
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22043-3068
Mailing Address - Country:US
Mailing Address - Phone:703-303-2806
Mailing Address - Fax:703-532-1615
Practice Address - Street 1:4660 KENMORE AVE
Practice Address - Street 2:SUITE 600
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-1313
Practice Address - Country:US
Practice Address - Phone:703-303-2806
Practice Address - Fax:703-532-1615
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-08
Last Update Date:2010-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101245174207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1568432987OtherPROVIDER INDIVIDUAL NPI