Provider Demographics
NPI:1437353604
Name:VIRGINIA DIABETES,OBESITY AND ENDOCRINOLOGY CENTER, LLC
Entity type:Organization
Organization Name:VIRGINIA DIABETES,OBESITY AND ENDOCRINOLOGY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:NAHRAIN
Authorized Official - Middle Name:H
Authorized Official - Last Name:ALZUBAIDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-802-9600
Mailing Address - Street 1:4211 FAIRFAX CORNER EAST AVE
Mailing Address - Street 2:SUITE 230
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-8622
Mailing Address - Country:US
Mailing Address - Phone:703-802-9600
Mailing Address - Fax:703-802-9602
Practice Address - Street 1:4211 FAIRFAX CORNER EAST AVE
Practice Address - Street 2:SUITE 230
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-8622
Practice Address - Country:US
Practice Address - Phone:703-802-9600
Practice Address - Fax:703-802-9602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-12
Last Update Date:2008-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101222033174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0101222033OtherVA STATE LICENSE
VA0101222033OtherVA STATE LICENSE
VAH71025Medicare UPIN