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Organization
NORTHERN VIRGINIA PAIN MANAGEMENT ASSOCIATES, LLC
Active
Organization
NORTHERN VIRGINIA PAIN MANAGEMENT ASSOCIATES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. CORELLA MARIE FENWICK (PRACTICE ADMINISTRATOR)
(301) 668-4842
Entity
Organization
Contact information
Practice address
124 PARK ST SE, SUITE 203, VIENNA, VA 22180-4654
(703) 319-1006
(703) 319-1008
Mailing address
141 THOMAS JOHNSON DR, SUITE 190, FREDERICK, MD 21702-4502
(301) 668-4403
(301) 668-4406
Taxonomy
Speciality
Code
Description
License number
State
208VP0000X
Pain Medicine Physician
Primary
PENDING
VA
Other
Enumeration date
11/12/2007
Last updated
11/12/2007
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