Provider Demographics
NPI:1487782280
Name:PASICOV, BENJAMIN (MD)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:
Last Name:PASICOV
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1340 OLD CHAIN BRIDGE RD
Mailing Address - Street 2:STE. 101
Mailing Address - City:MCLEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-3955
Mailing Address - Country:US
Mailing Address - Phone:703-893-2273
Mailing Address - Fax:703-893-4559
Practice Address - Street 1:1340 OLD CHAIN BRIDGE RD
Practice Address - Street 2:STE. 101
Practice Address - City:MCLEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-3955
Practice Address - Country:US
Practice Address - Phone:703-893-2273
Practice Address - Fax:703-893-4559
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101027134208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice