Organization
CCRM NORTHERN VIRGINIA, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MATT TYSON (DIRECTOR, MANAGED CARE CONTRACTING)
(615) 477-6677
Entity
Organization
Contact information
Practice address
8010 TOWERS CRESCENT DR, 5TH FLOOR, VIENNA, VA 22182-2710
(571) 789-2100
Mailing address
8010 TOWERS CRESCENT DR FL 5, VIENNA, VA 22182-2710
Taxonomy
Speciality
Code
Description
License number
State
261QA0006X
Ambulatory Fertility Facility
Primary
—
—
261QA1903X
Ambulatory Surgical Clinic/Center
—
—
Other
Enumeration date
03/31/2017
Last updated
07/13/2026
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