Provider Demographics
NPI:1922105477
Name:GERIATRICS GROUP OF NORTHERN VIRGINIA,INC.
Entity Type:Organization
Organization Name:GERIATRICS GROUP OF NORTHERN VIRGINIA,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MUHAMMAD
Authorized Official - Middle Name:A
Authorized Official - Last Name:ALI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-338-9526
Mailing Address - Street 1:5720 MERTON COURT
Mailing Address - Street 2:# 371
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22311-5956
Mailing Address - Country:US
Mailing Address - Phone:571-527-0932
Mailing Address - Fax:571-527-0824
Practice Address - Street 1:611 S. CARLIN SPRINGS ROAD
Practice Address - Street 2:SUIT # 514
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22204-1064
Practice Address - Country:US
Practice Address - Phone:571-527-0932
Practice Address - Fax:571-527-0824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-19
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA010234864207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA11448304OtherCAQH #
VA9127105Medicaid
VA010205875Medicaid
VAI-45024Medicare UPIN
VAG02168G01Medicare ID - Type UnspecifiedINDIVIDUAL
VAG02168Medicare ID - Type UnspecifiedGROUP