Provider Demographics
NPI:1679692974
Name:NOVA MEDICAL SERVICES,PLLC
Entity Type:Organization
Organization Name:NOVA MEDICAL SERVICES,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NEERAJA
Authorized Official - Middle Name:
Authorized Official - Last Name:THATHAGARI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-961-1119
Mailing Address - Street 1:PO BOX 734
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20122-0734
Mailing Address - Country:US
Mailing Address - Phone:703-961-1119
Mailing Address - Fax:703-961-1159
Practice Address - Street 1:4229 LAFAYETTE CENTER DR
Practice Address - Street 2:SUITE 1425
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20151-1261
Practice Address - Country:US
Practice Address - Phone:703-961-1119
Practice Address - Fax:703-961-1159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2007-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101237990261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
G02606Medicare PIN
VAI131415Medicare UPIN