Northern Virginia Neurology & Headache, PLLC
Organization Active NPI Neurology Physician · Annadale, VA
NPI 1043673544 · NPPES record last updated Apr 1, 2016
Key facts
- NPI
- 1043673544
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Neurology Physician 2084N0400X
- Legal business name
- NORTHERN VIRGINIA NEUROLOGY & HEADACHE, PLLC
- Practice address
- 7700 Little River Turnpike
Suite 605
Annadale, VA 22003-2400 - Phone
- (509) 572-5505
- NPI assigned
- Apr 1, 2016
- Organization subpart
- No
Authorized official
- Name
- Jung Gook Lim, M.D.
- Title
- Physician-Owner
- Phone
- (509) 572-5505
Practitioners 2
-
Jung Gook Lim, M.D.
-
Byung H. Park, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in DC
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20160610000156 | DC | Part B Supplier - Clinic/Group Practice | 2567752140 |
Receives reassigned benefits from 1 practitioner Practice locations: Annandale, VA |
National Provider Directory
Locations
7700 Little River Tpke
Ste 605
Annandale, VA 22003
Phone (509) 572-5505
4215 Evergreen Ln
Annandale, VA 22003
Phone (703) 649-4271
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Neurology Physician |
2084N0400X | Yes |
Addresses
Primary practice location
7700 Little River Turnpike
Suite 605
Annadale, VA 22003-2400
Mailing address
7700 Little River Turnpike
Suite 605
Annadale, VA 22003-2400
Phone (509) 572-5505
Other providers in Annadale, VA
All providers in Annadale, VA · Neurology Physician in Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 1, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.