Doctor Name: | DR. BENJAMIN PASICOV |
NPI Number: | 1487782280 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | 0101027134 |
Business Practice Address: | 1340 Old Chain Bridge Rd Ste. 101 Mclean, VA - 221013955 |
Business Phone Number: | 7038932273 |
Business Fax Number: | 7038934559 |
Mailing Address: | 1340 Old Chain Bridge Rd, Ste. 101 MCLEAN |
State: | VA |
Postal Code: | 221013955 |
Phone Number: | 7038932273 |
Fax Number: | 7038934559 |
NPI Enumeration Date: | 03/01/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 0101027134 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | VA |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |