Provider Demographics
NPI:1487101440
Name:ANITA N. WASAN MD PLC
Entity type:Organization
Organization Name:ANITA N. WASAN MD PLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:N
Authorized Official - Last Name:WASAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-992-7065
Mailing Address - Street 1:8115 OLD DOMINION DR
Mailing Address - Street 2:STE 220
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102-2325
Mailing Address - Country:US
Mailing Address - Phone:703-992-7065
Mailing Address - Fax:703-992-7063
Practice Address - Street 1:8115 OLD DOMINION DR
Practice Address - Street 2:STE 220
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22102-2325
Practice Address - Country:US
Practice Address - Phone:703-992-7065
Practice Address - Fax:703-992-7063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-07
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101237864261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center