Provider Demographics
NPI:1992197685
Name:NORTHERN VIRGINIA HEARING AID LLC
Entity Type:Organization
Organization Name:NORTHERN VIRGINIA HEARING AID LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-483-3610
Mailing Address - Street 1:1860 TOWN CENTER DR
Mailing Address - Street 2:SUITE 225
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-5896
Mailing Address - Country:US
Mailing Address - Phone:703-483-3610
Mailing Address - Fax:703-483-3616
Practice Address - Street 1:1860 TOWN CENTER DR
Practice Address - Street 2:SUITE 225
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-5896
Practice Address - Country:US
Practice Address - Phone:703-483-3610
Practice Address - Fax:703-483-3616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-04
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101042579332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment