Provider Demographics
NPI:1538394861
Name:PW UROLOGY OBS LLC
Entity type:Organization
Organization Name:PW UROLOGY OBS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ALI
Authorized Official - Middle Name:
Authorized Official - Last Name:SAJADI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-361-4129
Mailing Address - Street 1:9580 SURVEYOR CT
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-4406
Mailing Address - Country:US
Mailing Address - Phone:703-361-4129
Mailing Address - Fax:703-361-9442
Practice Address - Street 1:9580 SURVEYOR CT
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-4406
Practice Address - Country:US
Practice Address - Phone:703-361-4129
Practice Address - Fax:703-361-9442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-15
Last Update Date:2009-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA4274185OtherAETNA
VA7510306Medicaid
VA7685401OtherAETNA
VA87830005OtherCAREFIRST BC/BS
VA7966591OtherAETNA
VA87830004OtherCAREFIRST BC/BS
VA281216OtherAMERIGROUP
VA306085OtherANTHEM BC/BS
VA014761OtherANTHEM BC/BS
VA182822OtherANTHEM BC/BS
VA010198976Medicaid
VA87830002OtherCAREFIRST BC/BS
VA281216OtherAMERIGROUP
VAB05144Medicare UPIN
VA7510306Medicaid