Provider Demographics
NPI:1679544456
Name:NORTHERN VIRGINIA GYNECOLOGISTS INC
Entity Type:Organization
Organization Name:NORTHERN VIRGINIA GYNECOLOGISTS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:MOLINARI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-971-7633
Mailing Address - Street 1:6355 WALKER LN
Mailing Address - Street 2:SUITE 508
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22310-3245
Mailing Address - Country:US
Mailing Address - Phone:703-971-7633
Mailing Address - Fax:703-971-2219
Practice Address - Street 1:6355 WALKER LN
Practice Address - Street 2:SUITE 508
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22310-3245
Practice Address - Country:US
Practice Address - Phone:703-971-7633
Practice Address - Fax:703-971-2219
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
410051Medicare ID - Type Unspecified