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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