Provider Demographics
NPI:1568720225
Name:PHYSICAL MEDICINE ASSOCIATES, LTD
Entity Type:Organization
Organization Name:PHYSICAL MEDICINE ASSOCIATES, LTD
Other - Org Name:NATIONAL SPINE AND PAIN CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MAYO
Authorized Official - Middle Name:
Authorized Official - Last Name:FRIEDLIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-914-8000
Mailing Address - Street 1:3031 JAVIER RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4637
Mailing Address - Country:US
Mailing Address - Phone:703-914-8000
Mailing Address - Fax:703-642-1876
Practice Address - Street 1:8644 SUDLEY RD
Practice Address - Street 2:SUITE 117
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-4417
Practice Address - Country:US
Practice Address - Phone:703-914-8000
Practice Address - Fax:703-642-1876
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-01
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6688740006Medicare NSC