Provider Demographics
NPI:1447964184
Name:JARVANDI PEDIATRIC AND NUTRITION CENTER, LLC
Entity type:Organization
Organization Name:JARVANDI PEDIATRIC AND NUTRITION CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:JARVANDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-774-7577
Mailing Address - Street 1:5501 MERCHANTS VIEW SQ # 137
Mailing Address - Street 2:
Mailing Address - City:HAYMARKET
Mailing Address - State:VA
Mailing Address - Zip Code:20169-5439
Mailing Address - Country:US
Mailing Address - Phone:703-774-7577
Mailing Address - Fax:
Practice Address - Street 1:3700 JOSEPH SIEWICK DR STE 301
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-1739
Practice Address - Country:US
Practice Address - Phone:703-774-7577
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-09
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty