Provider Demographics
NPI:1326760497
Name:PERSONA PAYMENTS LLC
Entity Type:Organization
Organization Name:PERSONA PAYMENTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KAVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHABAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-405-5338
Mailing Address - Street 1:8120 WOODMONT AVE STE 180
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-2757
Mailing Address - Country:US
Mailing Address - Phone:703-405-5338
Mailing Address - Fax:
Practice Address - Street 1:1953 GALLOWS RD STE 120
Practice Address - Street 2:
Practice Address - City:TYSONS CORNER
Practice Address - State:VA
Practice Address - Zip Code:22182-4009
Practice Address - Country:US
Practice Address - Phone:703-291-0021
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-15
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RB0002XAllopathic & Osteopathic PhysiciansInternal MedicineObesity MedicineGroup - Multi-Specialty