Provider Demographics
NPI:1710918438
Name:NORTHERN VIRGINIA SURGICAL GROUP, PC
Entity Type:Organization
Organization Name:NORTHERN VIRGINIA SURGICAL GROUP, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SEID
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-560-7788
Mailing Address - Street 1:8316 ARLINGTON BLVD.
Mailing Address - Street 2:SUITE 630
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-5216
Mailing Address - Country:US
Mailing Address - Phone:703-560-7788
Mailing Address - Fax:703-573-5629
Practice Address - Street 1:8316 ARLINGTON BLVD.
Practice Address - Street 2:SUITE 630
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-5216
Practice Address - Country:US
Practice Address - Phone:703-560-7788
Practice Address - Fax:703-573-5629
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC09983Medicare PIN
DC699229Medicare PIN