Provider Demographics
NPI:1346514007
Name:MATERNAL FETAL MEDICINE ASSOCIATES OF NORTHERN VIRGINIA
Entity Type:Organization
Organization Name:MATERNAL FETAL MEDICINE ASSOCIATES OF NORTHERN VIRGINIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NISHA
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:VYAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-359-2466
Mailing Address - Street 1:4001 FAIR RIDGE DR
Mailing Address - Street 2:SUITE 304
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-2917
Mailing Address - Country:US
Mailing Address - Phone:703-359-2466
Mailing Address - Fax:703-359-1443
Practice Address - Street 1:4001 FAIR RIDGE DR
Practice Address - Street 2:SUITE 304
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-2917
Practice Address - Country:US
Practice Address - Phone:703-359-2466
Practice Address - Fax:703-359-1443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-28
Last Update Date:2012-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal MedicineGroup - Single Specialty