Provider Demographics
NPI:1659675460
Name:CENTREVILLE MEDICAL PRACTICE PLLC
Entity Type:Organization
Organization Name:CENTREVILLE MEDICAL PRACTICE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NASIR
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-631-5151
Mailing Address - Street 1:5715 CENTRE SQUARE DR
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20120-1916
Mailing Address - Country:US
Mailing Address - Phone:703-631-5151
Mailing Address - Fax:703-631-9754
Practice Address - Street 1:5715 CENTRE SQUARE DR
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20120-1916
Practice Address - Country:US
Practice Address - Phone:703-631-5151
Practice Address - Fax:703-631-9754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-08
Last Update Date:2011-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101248485207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1144388794OtherNPI OF DR. NASIR RAMIN