MEDICARE: GASTROENTEROLOGY ASSOCIATES OF NORTHERN VIRGINIA, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2080P0206X	Pediatric Gastroenterology Physician
2	207RG0100X	Gastroenterology Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CD8396	OTHER	VA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	178704	OTHER	VA	ANTHEM BCBS
4	104411	OTHER		KAISER
5	7916	OTHER		CAREFIRST BCBS

General Provider Information

NPI Number	:	1205884368
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GASTROENTEROLOGY ASSOCIATES OF NORTHERN VIRGINIA, LLC

Provider Business Mailing Address
First Line	:	3700 JOSEPH SIEWICK DR.
Second Line	:	SUITE 308
City	:	FAIRFAX
State	:	VA
Zip	:	22033-1739
Country	:	US
Telephone Number	:	703-716-8700
Fax Number	:	703-716-8703

Provider Business Practice Location Address
First Line	:	3700 JOSEPH SIEWICK DR.
Second Line	:	SUITE 308
City	:	FAIRFAX
State	:	VA
Zip	:	22033-1739
Country	:	US
Telephone Number	:	703-716-8700
Fax Number	:	703-716-8703

Authorized Official
Title or Position	:	CEO
Name	:	ALAN OLIVER
Credential	:	CEO
Telephone Number	:	786-530-3820

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	05/15/2025

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