Individual
NICHOLAS J TAVANI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
9625 SURVEYOR CT, SUITE 100, MANASSAS, VA 20110-4422
(703) 330-2233
(703) 330-2232
Mailing address
9625 SURVEYOR CT, SUITE 100, MANASSAS, VA 20110-4422
(703) 330-2233
(703) 330-2232
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0101044542
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
005605601
—
VA
Enumeration date
09/21/2005
Last updated
06/20/2013
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