Provider Demographics
NPI:1932470549
Name:NORTHERN VIRGINIA PELVIC SURGERY ASSOCIATES
Entity Type:Organization
Organization Name:NORTHERN VIRGINIA PELVIC SURGERY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:WELGOSS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-698-7100
Mailing Address - Street 1:3289 WOODBURN RD
Mailing Address - Street 2:SUITE 320
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-6800
Mailing Address - Country:US
Mailing Address - Phone:703-698-7100
Mailing Address - Fax:703-207-9487
Practice Address - Street 1:5215 LOUGHBORO RD NW
Practice Address - Street 2:SUITE 500
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016-2618
Practice Address - Country:US
Practice Address - Phone:703-698-7100
Practice Address - Fax:703-207-9487
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-13
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA616754OtherMEDICARE PTAN