Provider Demographics
NPI:1740337112
Name:NORTHERN VIRGINIA NEUROSURGERY INSTITUTE PC
Entity type:Organization
Organization Name:NORTHERN VIRGINIA NEUROSURGERY INSTITUTE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:RAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-645-0440
Mailing Address - Street 1:3301 WOODBURN RD
Mailing Address - Street 2:SUITE 209
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-1229
Mailing Address - Country:US
Mailing Address - Phone:703-645-0440
Mailing Address - Fax:703-645-0442
Practice Address - Street 1:3301 WOODBURN RD
Practice Address - Street 2:SUITE 209
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-1229
Practice Address - Country:US
Practice Address - Phone:703-645-0440
Practice Address - Fax:703-645-0442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101240737174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty