Provider Demographics
NPI:1609969930
Name:PEDIATRIC SURGICAL ASSOCIATES OF NORTHERN VIRGINIA
Entity Type:Organization
Organization Name:PEDIATRIC SURGICAL ASSOCIATES OF NORTHERN VIRGINIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLYSON
Authorized Official - Middle Name:A
Authorized Official - Last Name:ASKEW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-560-2236
Mailing Address - Street 1:3301 WOODBURN RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-1229
Mailing Address - Country:US
Mailing Address - Phone:703-560-2236
Mailing Address - Fax:703-876-4960
Practice Address - Street 1:3301 WOODBURN RD
Practice Address - Street 2:SUITE 205
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-1229
Practice Address - Country:US
Practice Address - Phone:703-560-2236
Practice Address - Fax:703-876-4960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101043562174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0101231159OtherVIRGINIA LICENSE
VAA57752Medicare UPIN