Provider Demographics
NPI:1952507121
Name:BATTLEFIELD FAMILY PRACTICE
Entity Type:Organization
Organization Name:BATTLEFIELD FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:TAVANI
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:703-330-2233
Mailing Address - Street 1:9625 SURVEYOR CT
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-4422
Mailing Address - Country:US
Mailing Address - Phone:703-330-2233
Mailing Address - Fax:703-330-2232
Practice Address - Street 1:9625 SURVEYOR CT
Practice Address - Street 2:SUITE 100
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-4422
Practice Address - Country:US
Practice Address - Phone:703-330-2233
Practice Address - Fax:703-330-2232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-25
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101044542174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA382570OtherANTHEM
VA005605601Medicaid
VA577722042OtherTRICARE CHAMPUS
VA005605601Medicaid
080007524Medicare PIN