Provider Demographics
NPI:1912023466
Name:NOVA ADVANCED PAIN MANAGEMENT PLLC
Entity Type:Organization
Organization Name:NOVA ADVANCED PAIN MANAGEMENT PLLC
Other - Org Name:THE SPINE CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEENI
Authorized Official - Middle Name:
Authorized Official - Last Name:BASSAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-257-2266
Mailing Address - Street 1:PO BOX 4600
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20108-4600
Mailing Address - Country:US
Mailing Address - Phone:703-257-2266
Mailing Address - Fax:703-257-2269
Practice Address - Street 1:8525 ROLLING RD
Practice Address - Street 2:SUITE 200
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-3647
Practice Address - Country:US
Practice Address - Phone:703-257-2266
Practice Address - Fax:703-257-2269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty
No207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC09411Medicare PIN