Healthcare Provider Details

I. General information

NPI: 1396891834
Provider Name (Legal Business Name): GASTROENTEROLOGY & HEPATOLOGY ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 08/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4660 KENMORE AVENUE SUITE 810
ALEXANDRIA VA
22304
US

IV. Provider business mailing address

4660 KENMORE AVENUE SUITE 810
ALEXANDRIA VA
22304
US

V. Phone/Fax

Practice location:
  • Phone: 703-823-0333
  • Fax: 703-823-8611
Mailing address:
  • Phone: 703-823-0333
  • Fax: 703-823-8611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RI0008X
TaxonomyHepatology Physician
License Number
License Number State

VIII. Authorized Official

Name: SURESH K MALHOTRA
Title or Position: PHYSICIAN OWNER PRESIDENT
Credential: MD FACP
Phone: 703-823-0333