Provider Demographics
NPI:1447278049
Name:NORTHERN VIRGINIA PSYCHIATRY PC
Entity type:Organization
Organization Name:NORTHERN VIRGINIA PSYCHIATRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BALRAJ
Authorized Official - Middle Name:
Authorized Official - Last Name:DHILLON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-773-0447
Mailing Address - Street 1:13608 HOLLY RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20155
Mailing Address - Country:US
Mailing Address - Phone:703-773-0447
Mailing Address - Fax:703-773-0448
Practice Address - Street 1:13505 DULLES TECHNOLOGY DR
Practice Address - Street 2:SUITE 1A
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20171-3401
Practice Address - Country:US
Practice Address - Phone:703-773-0447
Practice Address - Fax:703-773-0448
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012366022084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCN033OtherCAREFIRST/BC OF WASH DC
VA182080OtherANTHEM BCBS
DCN033OtherCAREFIRST/BC OF WASH DC