Organization
ENDOSCOPY & DIGESTIVE CENTER OF WOODBRIDGE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MOHAMMAD HOSSEIN RAZAVI MD (OWNER)
(703) 497-4222
Entity
Organization
Contact information
Practice address
14904 JEFFERSON DAVIS HWY, SUITE 103 & 104, WOODBRIDGE, VA 22191-3908
(703) 497-4222
(703) 492-0164
Mailing address
14904 JEFFERSON DAVIS HWY, SUITE 104, WOODBRIDGE, VA 22191-3908
(703) 497-4222
(703) 492-0164
Taxonomy
Speciality
Code
Description
License number
State
261QE0800X
Endoscopy Clinic/Center
Primary
0101049080
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
006077871
—
VA
Enumeration date
05/14/2008
Last updated
05/14/2008
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