Provider Demographics
NPI:1215307400
Name:NOVA PHYSICIAN WELLNESS CENTER PLLC
Entity type:Organization
Organization Name:NOVA PHYSICIAN WELLNESS CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROHIT
Authorized Official - Middle Name:
Authorized Official - Last Name:SURI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-865-6490
Mailing Address - Street 1:4211 FAIRFAX CORNER AVE E
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-8622
Mailing Address - Country:US
Mailing Address - Phone:703-865-6490
Mailing Address - Fax:703-865-6492
Practice Address - Street 1:3903 FAIR RIDGE DR
Practice Address - Street 2:SUITE 219
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-2943
Practice Address - Country:US
Practice Address - Phone:703-865-6490
Practice Address - Fax:703-865-6492
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-30
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty