Provider Demographics
NPI:1467680611
Name:NORTHERN VIRGINIA ENDOSCOPY CENTER
Entity Type:Organization
Organization Name:NORTHERN VIRGINIA ENDOSCOPY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:HOUSHANG
Authorized Official - Middle Name:
Authorized Official - Last Name:MAKIPOUR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-580-7433
Mailing Address - Street 1:2280 OPITZ BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22191-3362
Mailing Address - Country:US
Mailing Address - Phone:703-580-7433
Mailing Address - Fax:703-580-7437
Practice Address - Street 1:2280 OPITZ BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-3362
Practice Address - Country:US
Practice Address - Phone:703-580-7433
Practice Address - Fax:703-580-7437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-26
Last Update Date:2013-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0800XAmbulatory Health Care FacilitiesClinic/CenterEndoscopy