Provider Demographics
NPI:1902178817
Name:MEDICAL CENTER OF NORTHERN VIRGINIA
Entity Type:Organization
Organization Name:MEDICAL CENTER OF NORTHERN VIRGINIA
Other - Org Name:MEDICAL CENTER OF NORTHERN VIRGINIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:GOKEL
Authorized Official - Last Name:DELE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-533-0311
Mailing Address - Street 1:450 W BROAD ST
Mailing Address - Street 2:SUITE 420
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22046-3340
Mailing Address - Country:US
Mailing Address - Phone:703-533-0311
Mailing Address - Fax:703-533-0312
Practice Address - Street 1:450 W BROAD ST
Practice Address - Street 2:SUITE 420
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22046-3340
Practice Address - Country:US
Practice Address - Phone:703-533-0311
Practice Address - Fax:703-533-0312
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-08
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care