Provider Demographics
NPI:1063610855
Name:INFECTIOUS DISEASE SPECIALISTS OF NOVA LLC
Entity type:Organization
Organization Name:INFECTIOUS DISEASE SPECIALISTS OF NOVA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAVANYA
Authorized Official - Middle Name:
Authorized Official - Last Name:NUTANKALVA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:571-235-6705
Mailing Address - Street 1:3732 FREEHILL LN
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-5304
Mailing Address - Country:US
Mailing Address - Phone:571-235-6705
Mailing Address - Fax:866-511-1256
Practice Address - Street 1:3732 FREEHILL LN
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-5304
Practice Address - Country:US
Practice Address - Phone:571-235-6705
Practice Address - Fax:866-511-1256
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-03
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty