Provider Demographics
NPI:1578805636
Name:NOVA GYNECOLOGY ASSOCIATES LLC
Entity Type:Organization
Organization Name:NOVA GYNECOLOGY ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:NOONAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-249-9079
Mailing Address - Street 1:8642 RESECA LN
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22152-1411
Mailing Address - Country:US
Mailing Address - Phone:703-249-9079
Mailing Address - Fax:703-249-5186
Practice Address - Street 1:101 S WHITING ST
Practice Address - Street 2:SUITE 215
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-3418
Practice Address - Country:US
Practice Address - Phone:703-370-0550
Practice Address - Fax:703-249-5186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-26
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101032425174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty