Provider Demographics
NPI:1952512931
Name:NORTHERN VIRGINIA PRIMARY CARE ASSOCIATES
Entity Type:Organization
Organization Name:NORTHERN VIRGINIA PRIMARY CARE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-256-5680
Mailing Address - Street 1:7617 LITTLE RIVER TPKE
Mailing Address - Street 2:SUITE 600
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-2603
Mailing Address - Country:US
Mailing Address - Phone:703-256-5785
Mailing Address - Fax:703-658-1684
Practice Address - Street 1:7617 LITTLE RIVER TPKE
Practice Address - Street 2:SUITE 600
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-2603
Practice Address - Country:US
Practice Address - Phone:703-256-5785
Practice Address - Fax:703-658-1684
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC178828Medicare PIN