Provider Demographics
NPI:1710329693
Name:VIRGINIA HOSPITAL CENTER PHYSICIAN GROUP, LLC
Entity Type:Organization
Organization Name:VIRGINIA HOSPITAL CENTER PHYSICIAN GROUP, LLC
Other - Org Name:VIRGINIA HOSPITAL CENTER PHYSICIAN GROUP - SURGICAL SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:DEPAOLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-558-6104
Mailing Address - Street 1:1625 N GEORGE MASON DR
Mailing Address - Street 2:SUITE 334
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22205-3683
Mailing Address - Country:US
Mailing Address - Phone:703-717-4250
Mailing Address - Fax:703-717-4251
Practice Address - Street 1:1625 N GEORGE MASON DR
Practice Address - Street 2:SUITE 334
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22205-3683
Practice Address - Country:US
Practice Address - Phone:703-717-4250
Practice Address - Fax:703-717-4251
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-22
Last Update Date:2015-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty