NORTHERN VIRGINIA UROLOGY, PLLC (NPI# 1689769861) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1689769861 |
| Entity Type | Organization |
| Organization Name | NORTHERN VIRGINIA UROLOGY, PLLC |
| Practice Address |
10301 Democracy Ln Suite 410 Fairfax VA 22030-2545 |
| Practice Telephone | 7038765942 |
| Practice Fax Number | 7038765972 |
| Mailing Telephone | 7038765942 |
| Mailing Fax Number | 7038765972 |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2008-03-05 |
| Authorized Official Name | MRS. MARYJO MAYBERRY MCKENNA (CENTRAL BUSINESS OFFICE MANAGER) |
| Authorized Official Telephone | 7038765942 |
| Authorized Official Credential | CPC |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 174400000X | Specialist | Other Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AETNA PPO | 7845793 | 01 | |
| CAREFIRST BCBS | N190 | 01 | |
| VA | 1689769861 | 05 | |
| AETNA HMO | 1220932 | 01 |
| Street Address |
10301 DEMOCRACY LN SUITE 410 |
| City | FAIRFAX |
| State | VA |
| Zip Code | 22030-2545 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043211360 | Gregory S Sibley | Specialist | 10301 Democracy Ln, Fairfax, VA 22030-2545 | 2005-08-09 |
| 1366685240 | Marla Robin Gebaide | Chiropractor | 10301 Democracy Ln, Suite 110, Fairfax, VA 22030-2545 | 2009-04-08 |
| 1033351754 | Family Preservation Services, Inc | Community/Behavioral Health | 10301 Democracy Ln, Suite 275, Fairfax, VA 22030-2545 | 2009-03-26 |
| 1073797460 | Harold Agbahiwe | Radiology | 10301 Democracy Ln, Fairfax, VA 22030-2545 | 2007-12-21 |
| 1730212747 | Anu Gupta Md PC | Clinic/Center | 10301 Democracy Ln, Fairfax, VA 22030-2545 | 2007-03-13 |
| 1376629618 | Family Preservation Services, Inc | Community/Behavioral Health | 10301 Democracy Ln, Suite 275, Fairfax, VA 22030-2545 | 2006-10-30 |
| 1689604381 | Net Global Medical Services Inc | Durable Medical Equipment & Medical Supplies | 10301 Democracy Ln, Suite 100, Fairfax, VA 22030-2545 | 2006-07-05 |
| 1285612283 | Fairfax Rehabilitation, Incorporated | Clinic/Center | 10301 Democracy Ln, Suite 100, Fairfax, VA 22030-2545 | 2006-01-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205449477 | Perry Camp Jr. | Psychologist | 4403 Dixie Hill Rd, Unit 205, Fairfax, VA 22030 | 2020-08-28 |
| 1952940322 | Brightview Fair Oaks, LLC | Alzheimer Center (Dementia Center) | 12725 Lee Highway, Fairfax, VA 22030 | 2020-01-02 |
| 1245871524 | Tori Sprowl | Behavioral Analyst | 10430 Democracy Lane #102b & 103, Fairfax, VA 22030 | 2019-10-08 |
| 1528612124 | Paul Sarigianis | Student in an Organized Health Care Education/Training Program | 10379b Democracy Lane, Fairfax, VA 22030 | 2019-07-31 |
| 1497221303 | Kahak, Inc. | Day Training, Developmentally Disabled Services | 10560 Main Street Suite Ps100, Fairfax, VA 22030 | 2018-10-17 |
| 1689177073 | Shamoona Sharif | Dentist | 11050 Lee Hwy, Fairfax, VA 22030 | 2018-03-13 |
| 1205339538 | Rachael Lee Greene | Social Worker | 4403 Dixie Hill Rd. #206, Fairfax, VA 22030 | 2018-03-13 |
| 1558863027 | Jacqueline Renee Bauer | Skilled Nursing Facility | 10701 Main Street, Fairfax, VA 22030 | 2018-03-01 |
| 1275033607 | Philajo Global LLC | Non-emergency Medical Transport (VAN) | 4521 Billingham Street, Fairfax, VA 22030 | 2018-02-12 |
| 1376050401 | Alexander Harrison | Counselor | 4400 University Drive, Ms 2a2, Fairfax, VA 22030 | 2018-01-10 |
| Find all providers in zip 22030 | ||||
| Taxonomy Code | 174400000X |
| Grouping | Other Service Providers |
| Classification | Specialist |
| An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |
| Notes: Source: Expanded from Webster’s II New Riverside University Dictionary, Boston: Riverside Publishing Company, 1974. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841748829 | Katherine Thompson | Specialist | 3525 Mclean Ave, Fairfax, VA 22030-3007 | 2016-09-19 |
| 1932574019 | Tracie Reyes | Specialist | 11240 Waples Mill Rd Ste 100, Fairfax, VA 22030-6078 | 2015-12-01 |
| 1669845236 | Lauren Washington | Specialist | 11240 Waples Mill Rd Ste 301, Fairfax, VA 22030-6078 | 2015-11-04 |
| 1457746513 | Stephanie Bolger | Specialist | 10700 Zion Dr, Fairfax, VA 22032-3432 | 2015-04-05 |
| 1588066096 | Erin Stephenson | Specialist | 12881 Fair Valley Ct, Fairfax, VA 22033-3816 | 2014-09-16 |
| 1609114081 | Rachel Fannell Eisenfeld | Specialist | 10660 Page Ave, Fairfax, VA 22030-4098 | 2013-01-20 |
| 1043563422 | Maryann G Rozzell | Specialist | 3422 Barkley Dr, Fairfax, VA 22031-2724 | 2012-10-22 |
| 1861776551 | Wilbert Aguila | Specialist | 12678 Marcum Ct, Fairfax, VA 22033-2457 | 2011-09-29 |
| 1558692681 | Jacquelyn Lewis | Specialist | 1193 Ethan Allen Hwy, Fairfax, VT 05454-5433 | 2010-01-29 |
| 1861679896 | Linda O'toole Glick | Specialist | 11106 Del Rio Dr, Fairfax, VA 22030-5339 | 2008-01-22 |
| Find all providers in FAIRFAX | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.