Provider Demographics
NPI:1831300482
Name:S & D OF VIRGINIA INC
Entity Type:Organization
Organization Name:S & D OF VIRGINIA INC
Other - Org Name:FEMME CARE/PROSPERITY INTERNAL MEDICINE ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-876-9300
Mailing Address - Street 1:1801 ROBERT FULTON DR.
Mailing Address - Street 2:SUITE 140
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20191-4628
Mailing Address - Country:US
Mailing Address - Phone:703-876-9300
Mailing Address - Fax:703-876-9811
Practice Address - Street 1:1801 ROBERT FULTON DR STE 140
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20191-4347
Practice Address - Country:US
Practice Address - Phone:703-876-9300
Practice Address - Fax:703-876-9811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-25
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
555269Medicare PIN