Provider Demographics
NPI:1679836746
Name:NOVA OCCUPATIONAL HEALTH INC
Entity Type:Organization
Organization Name:NOVA OCCUPATIONAL HEALTH INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MADHUSUDAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PANTHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-468-0150
Mailing Address - Street 1:8714 SUDLEY RD
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-4405
Mailing Address - Country:US
Mailing Address - Phone:703-468-0150
Mailing Address - Fax:703-361-0346
Practice Address - Street 1:8714 SUDLEY RD
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-4405
Practice Address - Country:US
Practice Address - Phone:703-468-0150
Practice Address - Fax:703-361-0346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-22
Last Update Date:2012-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101048836207P00000X
VA01010575432083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational MedicineGroup - Multi-Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty