Northern Virginia Pain Management Associates, LLC

Primary specialty

Pain Medicine PhysicianTaxonomy code 208VP0000X

License

PENDING Issued in VA

Legal business name

NORTHERN VIRGINIA PAIN MANAGEMENT ASSOCIATES, LLC

Practice address

124 Park St SE
Suite 203
Vienna, VA 22180-4654

Phone

(703) 319-1006

Fax

(703) 319-1008

NPI assigned

Nov 12, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Corella Marie Fenwick

Title

Practice Administrator

Phone

(301) 668-4842

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1194825600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1194825600000",
    "number": "1093995607",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "141 THOMAS JOHNSON DR",
            "address_2": "SUITE 190",
            "city": "FREDERICK",
            "state": "MD",
            "postal_code": "217024502",
            "telephone_number": "301-668-4403",
            "fax_number": "301-668-4406"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "124 PARK ST SE",
            "address_2": "SUITE 203",
            "city": "VIENNA",
            "state": "VA",
            "postal_code": "221804654",
            "telephone_number": "703-319-1006",
            "fax_number": "703-319-1008"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHERN VIRGINIA PAIN MANAGEMENT ASSOCIATES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-12",
        "last_updated": "2007-11-12",
        "status": "A",
        "authorized_official_last_name": "FENWICK",
        "authorized_official_first_name": "CORELLA",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "301-668-4842",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "208VP0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pain Medicine, Pain Medicine",
            "state": "VA",
            "license": "PENDING",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Pain Medicine Physician in Vienna, VA
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.