Provider Demographics
NPI:1942392980
Name:PULMONARY & CRITICAL CARE SPECIALISTS OF NORTHERN VA, PC
Entity type:Organization
Organization Name:PULMONARY & CRITICAL CARE SPECIALISTS OF NORTHERN VA, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASST. PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:E
Authorized Official - Last Name:BELLERDINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-390-1172
Mailing Address - Street 1:3650 JOSEPH SIEWICK DR
Mailing Address - Street 2:#307
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-1710
Mailing Address - Country:US
Mailing Address - Phone:703-391-8804
Mailing Address - Fax:703-391-5659
Practice Address - Street 1:3650 JOSEPH SIEWICK DR
Practice Address - Street 2:#307
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-1710
Practice Address - Country:US
Practice Address - Phone:703-391-8804
Practice Address - Fax:703-391-5659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2009-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CI0740Medicare PIN
CH2092Medicare PIN
DC409228Medicare PIN
VAC05736Medicare PIN