Provider Demographics
NPI:1831805357
Name:DVA MEDICAL LLC
Entity type:Organization
Organization Name:DVA MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DARE
Authorized Official - Middle Name:
Authorized Official - Last Name:AJIBADE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:848-391-9189
Mailing Address - Street 1:400 ARMY NAVY DR APT 1127
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22202-4758
Mailing Address - Country:US
Mailing Address - Phone:848-391-9189
Mailing Address - Fax:
Practice Address - Street 1:8714 GEORGIA AVE
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-3601
Practice Address - Country:US
Practice Address - Phone:301-276-4691
Practice Address - Fax:301-589-2007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-27
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty