Provider Demographics
NPI:1912146473
Name:NOVA OTHOPEADICS & SPORTS MEDICINE CENTER, P.C.
Entity Type:Organization
Organization Name:NOVA OTHOPEADICS & SPORTS MEDICINE CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VINH
Authorized Official - Middle Name:BINH
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD, FAAOS
Authorized Official - Phone:703-288-0094
Mailing Address - Street 1:8206 LEESBURG PIKE
Mailing Address - Street 2:SUITE 409
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-2614
Mailing Address - Country:US
Mailing Address - Phone:703-288-0094
Mailing Address - Fax:703-288-0673
Practice Address - Street 1:8206 LEESBURG PIKE
Practice Address - Street 2:SUITE 409
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-2614
Practice Address - Country:US
Practice Address - Phone:703-288-0094
Practice Address - Fax:703-288-0673
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-06
Last Update Date:2009-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101236643207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA146705OtherMEDICARE PTAN
VA146705OtherMEDICARE PTAN