Organization
SPECIALTY PHYSICIANS OF NORTHERN VIRGINIA, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUZANNE BERGAMO (VP)
(804) 267-5950
Entity
Organization
Contact information
Practice address
24430 STONE SPRINGS BLVD, DULLES, VA 20166-2267
(703) 665-2430
Mailing address
2000 HEALTH PARK DR, BRENTWOOD, TN 37027-4692
(615) 373-7406
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1114157054
—
VA
Enumeration date
07/24/2009
Last updated
11/20/2025
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