Provider Demographics
NPI:1841497583
Name:NEUROLOGICAL INSTITUTE OF NORTHERN VIRGINIA, PC
Entity type:Organization
Organization Name:NEUROLOGICAL INSTITUTE OF NORTHERN VIRGINIA, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HAIDEH
Authorized Official - Middle Name:YAZDANI
Authorized Official - Last Name:SABET
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-370-9411
Mailing Address - Street 1:5130 DUKE ST
Mailing Address - Street 2:SUITE 9
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-2924
Mailing Address - Country:US
Mailing Address - Phone:703-370-9411
Mailing Address - Fax:703-370-9417
Practice Address - Street 1:5130 DUKE ST
Practice Address - Street 2:SUITE 9
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-2924
Practice Address - Country:US
Practice Address - Phone:703-370-9411
Practice Address - Fax:703-370-9417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-27
Last Update Date:2010-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101235251174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010111528Medicaid
VA010111528Medicaid
VAG01494Medicare ID - Type UnspecifiedMEDICARE GROUP ID