Organization
OBGYN OF VIRGINIA, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHAWANA MUFTI (OWNER)
(571) 249-0717
Entity
Organization
Contact information
Practice address
3930 PENDER DR, SUITE 60, FAIRFAX, VA 22030-0985
(571) 249-0717
Mailing address
10351 ELIZABETH ST, GREAT FALLS, VA 22066-2922
(571) 249-0717
(703) 865-4167
Taxonomy
Speciality
Code
Description
License number
State
207VG0400X
Gynecology Physician
Primary
0101241302
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1023237997
—
VA
Enumeration date
05/12/2014
Last updated
05/12/2014
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