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NPI Code Detail

MEDICARE: LOUDOUN MEDICAL GROUP, PC

MEDICARE: LOUDOUN MEDICAL GROUP, PC
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
1207R00000XInternal Medicine Physician

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1CG8678OTHERVARR MEDICARE PIN

General Provider Information

NPI Number : 1538293147
Entity Type Code : Organization
Provider Name (Legal Business Name) : LOUDOUN MEDICAL GROUP, PC
Provider Business Mailing Address
First Line : 224-D CORNWALL STREET, NW
Second Line : SUITE 403
City : LEESBURG
State : VA
Zip : 20176-2704
Country : US
Telephone Number : 703-737-6010
Fax Number : 703-443-8643
Provider Business Practice Location Address
First Line : 2 PIDGEON HILL DRIVE
Second Line : SUITE 400
City : STERLING
State : VA
Zip : 20165-6129
Country : US
Telephone Number : 703-430-7090
Fax Number : 703-444-9878
Authorized Official
Title or Position : CEO
Name : MARY BETH TAMASY
Credential :
Telephone Number : 703-737-6010
Provider Enumeration Date : 03/15/2007
Last Update Date : 04/24/2023

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Directions to “LOUDOUN MEDICAL GROUP, PC ” Practice Location

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