Provider Demographics
NPI:1457450918
Name:NOVA ORTHOPEDIC & SPINE CARE, PC
Entity Type:Organization
Organization Name:NOVA ORTHOPEDIC & SPINE CARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAYMAUN
Authorized Official - Middle Name:M
Authorized Official - Last Name:LOTFI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-490-1112
Mailing Address - Street 1:14605 POTOMAC BRANCH DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-3336
Mailing Address - Country:US
Mailing Address - Phone:703-490-1112
Mailing Address - Fax:703-878-8732
Practice Address - Street 1:2028 OPITZ BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-3306
Practice Address - Country:US
Practice Address - Phone:703-490-1112
Practice Address - Fax:703-490-8064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC09077Medicare PIN
VA5312540001Medicare NSC