Provider Demographics
NPI:1619049632
Name:LINDA P NIMS MD & ASSOC
Entity Type:Organization
Organization Name:LINDA P NIMS MD & ASSOC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:P
Authorized Official - Last Name:NIMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-938-5148
Mailing Address - Street 1:243 CHURCH ST NW
Mailing Address - Street 2:SUITE 200 C
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22180-4434
Mailing Address - Country:US
Mailing Address - Phone:703-938-5148
Mailing Address - Fax:703-790-1983
Practice Address - Street 1:243 CHURCH ST NW
Practice Address - Street 2:SUITE 200 C
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22180-4434
Practice Address - Country:US
Practice Address - Phone:703-938-5148
Practice Address - Fax:703-790-1983
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101028419207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAG00477Medicare PIN