Provider Demographics
NPI:1710376652
Name:NOVA HEADACHE & CHRONIC PAIN CENTER
Entity Type:Organization
Organization Name:NOVA HEADACHE & CHRONIC PAIN CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:703-425-5550
Mailing Address - Street 1:8993 COTSWOLD DR
Mailing Address - Street 2:
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22015-1666
Mailing Address - Country:US
Mailing Address - Phone:703-425-5550
Mailing Address - Fax:703-425-5558
Practice Address - Street 1:8993 COTSWOLD DR
Practice Address - Street 2:
Practice Address - City:BURKE
Practice Address - State:VA
Practice Address - Zip Code:22015-1666
Practice Address - Country:US
Practice Address - Phone:703-425-5550
Practice Address - Fax:703-425-5558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-15
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0104557221261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center