Provider Demographics
NPI:1790161545
Name:NOVA ALLERGY GROUP, LLC
Entity type:Organization
Organization Name:NOVA ALLERGY GROUP, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:AMIT
Authorized Official - Middle Name:
Authorized Official - Last Name:MATHURIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-955-0807
Mailing Address - Street 1:24600 MILLSTREAM DR STE 430
Mailing Address - Street 2:
Mailing Address - City:ALDIE
Mailing Address - State:VA
Mailing Address - Zip Code:20105-3512
Mailing Address - Country:US
Mailing Address - Phone:703-327-3300
Mailing Address - Fax:703-542-6785
Practice Address - Street 1:24600 MILLSTREAM DR STE 430
Practice Address - Street 2:
Practice Address - City:ALDIE
Practice Address - State:VA
Practice Address - Zip Code:20105-3512
Practice Address - Country:US
Practice Address - Phone:703-327-3300
Practice Address - Fax:703-542-6785
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-04
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty