Provider Demographics
NPI:1992869689
Name:NORTHERN VIRGINIA FAMILY PRACTICE ASSOCIATES
Entity type:Organization
Organization Name:NORTHERN VIRGINIA FAMILY PRACTICE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:K
Authorized Official - Last Name:DIDONATO
Authorized Official - Suffix:
Authorized Official - Credentials:RHIA
Authorized Official - Phone:703-647-4966
Mailing Address - Street 1:2445 ARMY NAVY DR STE 400
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22206-2988
Mailing Address - Country:US
Mailing Address - Phone:703-379-8879
Mailing Address - Fax:703-998-6821
Practice Address - Street 1:2445 ARMY NAVY DR STE 400
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22206-2988
Practice Address - Country:US
Practice Address - Phone:703-379-8879
Practice Address - Fax:703-998-6821
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA20969-01207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA127107Medicare ID - Type Unspecified