Provider Demographics
NPI:1699857128
Name:VIRGINIA FAMILY MEDICINE, PLLC
Entity Type:Organization
Organization Name:VIRGINIA FAMILY MEDICINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRINCIPAL
Authorized Official - Prefix:DR
Authorized Official - First Name:KAVIAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:MILANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-560-6268
Mailing Address - Street 1:9401 LEE HIGHWAY
Mailing Address - Street 2:SUITE 400
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031
Mailing Address - Country:US
Mailing Address - Phone:703-383-4836
Mailing Address - Fax:703-383-4911
Practice Address - Street 1:9401 LEE HWY
Practice Address - Street 2:SUITE 400
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-1849
Practice Address - Country:US
Practice Address - Phone:703-383-4836
Practice Address - Fax:703-383-4911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101057147207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5633320Medicaid
VA5633320Medicaid