Provider Demographics
NPI:1366872285
Name:SEVA MEDICAL GROUP LLC
Entity type:Organization
Organization Name:SEVA MEDICAL GROUP LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ANIL
Authorized Official - Middle Name:
Authorized Official - Last Name:GUPTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-969-7775
Mailing Address - Street 1:11490 COMMERCE PARK DR
Mailing Address - Street 2:SUITE 525
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20191-1557
Mailing Address - Country:US
Mailing Address - Phone:571-367-2261
Mailing Address - Fax:
Practice Address - Street 1:24805 PINEBROOK RD
Practice Address - Street 2:SUITE 101
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20152-4126
Practice Address - Country:US
Practice Address - Phone:571-367-2261
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-13
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty