Provider Demographics
NPI:1871596692
Name:DOSOVA, NOEMI S (MD)
Entity type:Individual
Prefix:
First Name:NOEMI
Middle Name:S
Last Name:DOSOVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NOEMI
Other - Middle Name:S
Other - Last Name:DOSA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3650 JOSEPH SIEWICK DR
Mailing Address - Street 2:STE 101
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-1700
Mailing Address - Country:US
Mailing Address - Phone:703-391-0900
Mailing Address - Fax:703-323-2665
Practice Address - Street 1:3650 JOSEPH SIEWICK DR
Practice Address - Street 2:STE 101
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-1700
Practice Address - Country:US
Practice Address - Phone:703-391-0900
Practice Address - Fax:703-323-2665
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101037733208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6799515Medicaid
G01904Medicare UPIN