Provider Demographics
NPI:1346001153
Name:NOVA DIALYSIS ANNANDALE
Entity Type:Organization
Organization Name:NOVA DIALYSIS ANNANDALE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:MINESSIA
Authorized Official - Middle Name:ZARITA
Authorized Official - Last Name:PEARSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-943-7808
Mailing Address - Street 1:9320 ANNAPOLIS RD STE 200
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-3121
Mailing Address - Country:US
Mailing Address - Phone:301-577-1007
Mailing Address - Fax:
Practice Address - Street 1:1776 CAMBRIDGE DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23238-3203
Practice Address - Country:US
Practice Address - Phone:703-642-0011
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NOVA DIALYSIS ANNANDALE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-01-18
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment