Provider Demographics
NPI:1518301035
Name:NOVA MEDICAL CENTER, PC
Entity Type:Organization
Organization Name:NOVA MEDICAL CENTER, PC
Other - Org Name:VIRGINIA PAIN & WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUE
Authorized Official - Middle Name:H
Authorized Official - Last Name:BEDI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:571-926-8918
Mailing Address - Street 1:1800 TOWN CENTER DR
Mailing Address - Street 2:SUITE 315B
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-3215
Mailing Address - Country:US
Mailing Address - Phone:571-926-8918
Mailing Address - Fax:703-342-0360
Practice Address - Street 1:1800 TOWN CENTER DR
Practice Address - Street 2:SUITE 315B
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-3215
Practice Address - Country:US
Practice Address - Phone:571-926-8918
Practice Address - Fax:703-342-0360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-26
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104556266111N00000X
VA0104556915111N00000X
VA01012512222081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty