Organization
NORTHERN VIRGINIA UROLOGY, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MARYJO MAYBERRY MCKENNA CPC (CENTRAL BUSINESS OFFICE MANAGER)
(703) 876-5942
Entity
Organization
Contact information
Practice address
10301 DEMOCRACY LN, SUITE 410, FAIRFAX, VA 22030-2545
(703) 876-5942
(703) 876-5972
Mailing address
10301 DEMOCRACY LN, SUITE 410, FAIRFAX, VA 22030-2545
(703) 876-5942
(703) 876-5972
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1220932
AETNA HMO
—
05
—
1689769861
—
VA
01
—
7845793
AETNA PPO
—
01
—
N190
CAREFIRST BCBS
—
Enumeration date
10/04/2006
Last updated
03/05/2008
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