Advanced Brain Centers of VA

Primary specialty

Undersea and Hyperbaric Medicine (Emergency Medicine) PhysicianTaxonomy code 207PE0005X

Legal business name

ADVANCED BRAIN CENTERS OF VA

Practice address

1860 Town Center Drive
Suite G220
Reston, VA 20190

Phone

(571) 201-8238

Fax

(703) 709-1119

NPI assigned

Apr 17, 2023

Last updated

Aug 16, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Phillip A Defina, PHD

Title

Owner

Phone

(571) 201-8238

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1681689600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1692144000000",
    "number": "1659067122",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1860 TOWN CENTER DRIVE",
            "address_2": "SUITE G220",
            "city": "RESTON",
            "state": "VA",
            "postal_code": "20190",
            "telephone_number": "571-201-8238",
            "fax_number": "703-709-1119"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1860 TOWN CENTER DRIVE",
            "address_2": "SUITE G220",
            "city": "RESTON",
            "state": "VA",
            "postal_code": "20190",
            "telephone_number": "571-201-8238",
            "fax_number": "703-709-1119"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED BRAIN CENTERS OF VA",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-04-17",
        "last_updated": "2023-08-16",
        "certification_date": "2023-06-01",
        "status": "A",
        "authorized_official_last_name": "DEFINA",
        "authorized_official_first_name": "PHILLIP",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "571-201-8238",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "207PE0005X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Emergency Medicine, Undersea and Hyperbaric Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Undersea and Hyperbaric Medicine (Emergency Medicine) Physician in Reston, VA
• Providers in Reston, VA by specialty
• Undersea and Hyperbaric Medicine (Emergency Medicine) Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2023; 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.