Provider Demographics
NPI:1700960986
Name:NORTHERN VIRGINIA BRAIN AND SPINE, INC
Entity Type:Organization
Organization Name:NORTHERN VIRGINIA BRAIN AND SPINE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANJE
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-437-1160
Mailing Address - Street 1:11654 PLAZA AMERICA DR
Mailing Address - Street 2:#528
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-4700
Mailing Address - Country:US
Mailing Address - Phone:703-437-1160
Mailing Address - Fax:703-437-1161
Practice Address - Street 1:46400 BENEDICT DR
Practice Address - Street 2:SUITE 001
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20164-6604
Practice Address - Country:US
Practice Address - Phone:703-437-1160
Practice Address - Fax:703-437-1161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2010-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101239215207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty