1386027019 NPI number — HEMATOLOGY ONCOLOGY OF TYSONS PLLC

Table of content: (NPI 1386027019)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386027019 NPI number — HEMATOLOGY ONCOLOGY OF TYSONS PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEMATOLOGY ONCOLOGY OF TYSONS PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
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NPI Number Information

NPI Number:
1386027019
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/26/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8290 OLD COURTHOUSE RD STE C
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VIENNA
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22182-3837
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-704-3288
Provider Business Mailing Address Fax Number:
704-666-8844

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8290 OLD COURTHOUSE RD STE C
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VIENNA
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22182-3837
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-678-8772
Provider Business Practice Location Address Fax Number:
703-666-8844
Provider Enumeration Date:
06/30/2015

Additional Information

Authorized Official

Authorized Official Last Name:
SAHEBI
Authorized Official First Name:
CAMILA
Authorized Official Middle Name:
Authorized Official Title or Position:
MD
Authorized Official Telephone Number:
732-678-8772

Provider Taxonomy Codes

  • Taxonomy code: 261QX0200X , with the licence number:  0101255947 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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