Provider Demographics
NPI:1497927347
Name:RAVI R IYER
Entity Type:Organization
Organization Name:RAVI R IYER
Other - Org Name:NOVA HEALTH MGMT & RESEARCH GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAVI
Authorized Official - Middle Name:R
Authorized Official - Last Name:IYER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-404-5900
Mailing Address - Street 1:21495 RIDGETOP CIR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20166-6512
Mailing Address - Country:US
Mailing Address - Phone:703-404-5900
Mailing Address - Fax:
Practice Address - Street 1:13505 DULLES TECHNOLOGY DR
Practice Address - Street 2:SUITE 1A
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20171-3401
Practice Address - Country:US
Practice Address - Phone:703-404-5900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-01
Last Update Date:2011-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101053203207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA580588Medicaid
DCG00349Medicare PIN
VAC06284Medicare PIN