1285021345 NPI number — LOUDOUN MEDICAL GROUP, PC

Table of content: (NPI 1285021345)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285021345 NPI number — LOUDOUN MEDICAL GROUP, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LOUDOUN MEDICAL GROUP, PC
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:
THE EYE CENTER
Provider Other Organization Name Type Code:
3
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:
1285021345
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/24/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
224D CORNWALL ST NW STE 403
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEESBURG
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
20176-2704
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-737-6001
Provider Business Mailing Address Fax Number:
703-443-8643

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8751 SUDLEY RD 2ND FLOOR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MANASSAS
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
20110-8320
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
571-229-1155
Provider Business Practice Location Address Fax Number:
571-921-1195
Provider Enumeration Date:
04/16/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
TAMASY
Authorized Official First Name:
MARY BETH
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
703-737-6010

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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