Provider Demographics
NPI:1912302555
Name:NOVA PSYCHIATRIST, LLC
Entity Type:Organization
Organization Name:NOVA PSYCHIATRIST, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MADAN
Authorized Official - Middle Name:KUMAR
Authorized Official - Last Name:UPRETY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-596-4796
Mailing Address - Street 1:12359 SUNRISE VALLEY DR
Mailing Address - Street 2:SUITE 320
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20191-3462
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12359 SUNRISE VALLEY DR
Practice Address - Street 2:SUITE 320
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20191-3462
Practice Address - Country:US
Practice Address - Phone:703-596-4796
Practice Address - Fax:703-435-6747
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-24
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No364SP0807XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Child & AdolescentGroup - Single Specialty