Provider Demographics
NPI:1407050719
Name:WOMEN PHYSICIANS OF NORTHERN VIRGINIA, PC
Entity Type:Organization
Organization Name:WOMEN PHYSICIANS OF NORTHERN VIRGINIA, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:J
Authorized Official - Last Name:IVEY-CROWE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-463-9568
Mailing Address - Street 1:46179 WESTLAKE DRIVE
Mailing Address - Street 2:SUITE 350
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20165-3219
Mailing Address - Country:US
Mailing Address - Phone:703-463-9568
Mailing Address - Fax:703-724-9538
Practice Address - Street 1:46179 WESTLAKE DR STE 350
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20165-5882
Practice Address - Country:US
Practice Address - Phone:703-463-9568
Practice Address - Fax:703-724-9538
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101102474174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty