Provider Demographics
NPI:1912191420
Name:MEDICAL SPECIALISTS OF NORTHERN VIRGINIA INC
Entity Type:Organization
Organization Name:MEDICAL SPECIALISTS OF NORTHERN VIRGINIA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:GREWING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-634-1699
Mailing Address - Street 1:8101 HINSON FARM RD STE 219
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22306-3406
Mailing Address - Country:US
Mailing Address - Phone:703-360-8383
Mailing Address - Fax:703-360-0263
Practice Address - Street 1:8101 HINSON FARM RD STE 219
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22306-3406
Practice Address - Country:US
Practice Address - Phone:703-360-8383
Practice Address - Fax:703-360-0263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-29
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty