Provider Demographics
NPI:1023246725
Name:NORTHERN VIRGINIA PHYSICIANS SERVICES,LLC
Entity type:Organization
Organization Name:NORTHERN VIRGINIA PHYSICIANS SERVICES,LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MASSOUD
Authorized Official - Middle Name:
Authorized Official - Last Name:SABERINIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-526-0666
Mailing Address - Street 1:PO BOX 9743
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102-0743
Mailing Address - Country:US
Mailing Address - Phone:703-526-0666
Mailing Address - Fax:
Practice Address - Street 1:1715 N GEORGE MASON DR
Practice Address - Street 2:408
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22205-3609
Practice Address - Country:US
Practice Address - Phone:703-526-0666
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-01
Last Update Date:2009-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101-049635174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
F61197Medicare UPIN