Provider Demographics
NPI:1558474973
Name:GLENNA R ANDERSEN MD DARYA B MAANAVI MD LTD
Entity type:Organization
Organization Name:GLENNA R ANDERSEN MD DARYA B MAANAVI MD LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GLENNA
Authorized Official - Middle Name:R
Authorized Official - Last Name:ANDERSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-560-1611
Mailing Address - Street 1:6035 BURKE CENTRE PKWY
Mailing Address - Street 2:SUITE 390
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22015-3750
Mailing Address - Country:US
Mailing Address - Phone:703-978-1196
Mailing Address - Fax:703-978-7762
Practice Address - Street 1:8501 ARLINGTON BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031
Practice Address - Country:US
Practice Address - Phone:703-560-1611
Practice Address - Fax:703-573-0217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA411072Medicare PIN