1154546158 NPI number — GASTROENTEROLOGY CENTER OF NORTHERN VIRGINIA LTD

Table of content: DR. SCOTT MARTIN HIBBETS O.D. (NPI 1215193776)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154546158 NPI number — GASTROENTEROLOGY CENTER OF NORTHERN VIRGINIA LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GASTROENTEROLOGY CENTER OF NORTHERN VIRGINIA LTD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154546158
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/15/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3299 WOODBURN ROAD
Provider Second Line Business Mailing Address:
SUITE 220
Provider Business Mailing Address City Name:
ANNANDALE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22003
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-560-6106
Provider Business Mailing Address Fax Number:
703-204-1968

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3299 WOODBURN ROAD
Provider Second Line Business Practice Location Address:
SUITE 220
Provider Business Practice Location Address City Name:
ANNANDALE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-560-6106
Provider Business Practice Location Address Fax Number:
703-204-1968
Provider Enumeration Date:
04/16/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HERMAN
Authorized Official First Name:
GABRIEL
Authorized Official Middle Name:
B
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
703-560-6106

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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