Provider Demographics
NPI:1841349107
Name:SURGICAL SPECIALISTS OF NORTHERN VIRGINIA
Entity type:Organization
Organization Name:SURGICAL SPECIALISTS OF NORTHERN VIRGINIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:WEINTRITT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-313-8808
Mailing Address - Street 1:114 QUAY ST
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-2609
Mailing Address - Country:US
Mailing Address - Phone:703-313-8808
Mailing Address - Fax:703-313-8850
Practice Address - Street 1:8988 LORTON STATION BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:LORTON
Practice Address - State:VA
Practice Address - Zip Code:22079-4733
Practice Address - Country:US
Practice Address - Phone:703-313-8808
Practice Address - Fax:703-313-8850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAG01411Medicare ID - Type Unspecified