Provider Demographics
NPI:1710258785
Name:NEUROMUSCULAR, SPINE AND JOINT CARE SPECIALISTS,PLLC
Entity Type:Organization
Organization Name:NEUROMUSCULAR, SPINE AND JOINT CARE SPECIALISTS,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAYNOVSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-364-3536
Mailing Address - Street 1:6920 BRADDOCK ROAD
Mailing Address - Street 2:SUITE B122
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003
Mailing Address - Country:US
Mailing Address - Phone:703-364-3536
Mailing Address - Fax:703-503-2246
Practice Address - Street 1:8424 DORSEY CIR
Practice Address - Street 2:SUITE 101
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-8301
Practice Address - Country:US
Practice Address - Phone:703-364-3536
Practice Address - Fax:703-503-2246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-23
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101226840208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005656M65Medicare PIN
VAH22418Medicare UPIN