| Ekdom Neuropsychology Group | |
|
3040 Williams Dr Suite 402 Fairfax VA 22031-4618 | |
| (703) 573-3575 | |
| (703) 573-3574 |
| Full Name | Ekdom Neuropsychology Group |
|---|---|
| Speciality | Clinical Neuropsychologist |
| Location | 3040 Williams Dr, Fairfax, Virginia |
| Authorized Official Name and Position | Nicole Hashemian (OWNER) |
| Authorized Official Contact | 7035733573 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ekdom Neuropsychology Group 3040 Williams Dr Suite 402 Fairfax VA 22031-4618 Ph: (703) 573-3575 | Ekdom Neuropsychology Group 3040 Williams Dr Suite 402 Fairfax VA 22031-4618 Ph: (703) 573-3575 |
| NPI Number | 1194804914 |
|---|---|
| Provider Enumeration Date | 11/03/2006 |
| Last Update Date | 06/04/2024 |
| Certification Date | 06/04/2024 |
| Medicare PECOS PAC ID | 6901101807 |
|---|---|
| Medicare Enrollment ID | O20160301001147 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194804914 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103G00000X | Clinical Neuropsychologist | 081001775 (Virginia) | Primary |
| Provider Name | Barry B Ekdom |
|---|---|
| Provider Type | Practitioner - Psychologist Billing Independently |
| Provider Identifiers | NPI Number: 1457532756 PECOS PAC ID: 6608943840 Enrollment ID: I20080930000305 |
| Provider Name | Nicole N Hashemian |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1861008492 PECOS PAC ID: 7416377254 Enrollment ID: I20201016002579 |
| Provider Name | Joanna D Luzzi |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1922651454 PECOS PAC ID: 6305248295 Enrollment ID: I20210715000104 |
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