| Endocrine And Diabetes Center P.c. | |
|
301 Maple Ave W Suite 120 Vienna VA 22180-4301 | |
| (703) 938-8885 | |
| (703) 242-2437 |
| Full Name | Endocrine And Diabetes Center P.c. |
|---|---|
| Speciality | Internal Medicine |
| Location | 301 Maple Ave W, Vienna, Virginia |
| Authorized Official Name and Position | Ali M Safa (PRESIDENT) |
| Authorized Official Contact | 7039388885 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Endocrine And Diabetes Center P.c. 301 Maple Ave W Suite 120 Vienna VA 22180-4301 Ph: (703) 938-8885 | Endocrine And Diabetes Center P.c. 301 Maple Ave W Suite 120 Vienna VA 22180-4301 Ph: (703) 938-8885 |
| NPI Number | 1154487007 |
|---|---|
| Provider Enumeration Date | 12/28/2006 |
| Last Update Date | 10/14/2013 |
| Medicare PECOS PAC ID | 8224008891 |
|---|---|
| Medicare Enrollment ID | O20040729001555 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154487007 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RE0101X | Internal Medicine - Endocrinology, Diabetes & Metabolism | 101040528 (Virginia) | Primary |
| Provider Name | Ali M Safa |
|---|---|
| Provider Type | Practitioner - Endocrinology |
| Provider Identifiers | NPI Number: 1952475048 PECOS PAC ID: 2466422043 Enrollment ID: I20041227000215 |
| Provider Name | Mary J Bozzelli |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871662338 PECOS PAC ID: 1951402932 Enrollment ID: I20070723000557 |
| Provider Name | Edward G Movius |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1427112788 PECOS PAC ID: 7517018963 Enrollment ID: I20090625000400 |
| Provider Name | Kavitha Felix Johnson |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1316135403 PECOS PAC ID: 5991028482 Enrollment ID: I20150109000326 |
| Provider Name | Christine A Gilloon |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1073097952 PECOS PAC ID: 4981957065 Enrollment ID: I20181019002280 |
| Provider Name | Elizabeth Drew Idris |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255826350 PECOS PAC ID: 0345599593 Enrollment ID: I20190920001985 |
| Provider Name | Michelle Waverly Evans |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760104178 PECOS PAC ID: 0840663514 Enrollment ID: I20230228000258 |
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