Provider Demographics
NPI:1770632630
Name:NORTHERN VIRGINIA NEPHROLOGY ASSOCIATES PC
Entity type:Organization
Organization Name:NORTHERN VIRGINIA NEPHROLOGY ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MAGNUS
Authorized Official - Middle Name:K
Authorized Official - Last Name:IKHINMWIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-204-1614
Mailing Address - Street 1:10882 MIMOSA PLACE
Mailing Address - Street 2:
Mailing Address - City:OAKTON
Mailing Address - State:VA
Mailing Address - Zip Code:22124
Mailing Address - Country:US
Mailing Address - Phone:703-204-1614
Mailing Address - Fax:703-204-1826
Practice Address - Street 1:3650 JOSEPH SIEWICK DR STE 310
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-1715
Practice Address - Country:US
Practice Address - Phone:703-758-8800
Practice Address - Fax:703-758-9500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101057344207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
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