| Premier Health Consultants Of Northern Virginia Inc | |
|
1860 Town Center Dr Ste 260 Reston VA 20190-5899 | |
| (703) 662-3359 | |
| (703) 997-2627 |
| Full Name | Premier Health Consultants Of Northern Virginia Inc |
|---|---|
| Speciality | Internal Medicine |
| Location | 1860 Town Center Dr Ste 260, Reston, Virginia |
| Authorized Official Name and Position | Kavita Namjoshi (OWNER) |
| Authorized Official Contact | 7758488287 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Premier Health Consultants Of Northern Virginia Inc 21882 Hyde Park Dr Ashburn VA 20147-6911 Ph: () - | Premier Health Consultants Of Northern Virginia Inc 1860 Town Center Dr Ste 260 Reston VA 20190-5899 Ph: (703) 662-3359 |
| NPI Number | 1164030458 |
|---|---|
| Provider Enumeration Date | 07/22/2020 |
| Last Update Date | 09/10/2020 |
| Medicare PECOS PAC ID | 3577983642 |
|---|---|
| Medicare Enrollment ID | O20201013000022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164030458 | NPI | - | NPPES |
| 6087248 | Medicaid | VA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Kavita Shantanu Namjoshi |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1508840380 PECOS PAC ID: 0840240479 Enrollment ID: I20140925000750 |
| Provider Name | Anabelle Merrera |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073184362 PECOS PAC ID: 6800292749 Enrollment ID: I20210901001923 |
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