Healthcare Provider Details

I. General information

NPI: 1396770939
Provider Name (Legal Business Name): NO VA GASTRO ASSOC LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 08/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 WOODBURN ROAD SUITE 107
ANNANDALE VA
22003-1297
US

IV. Provider business mailing address

3301 WOODBURN ROAD SUITE 107
ANNANDALE VA
22003-1297
US

V. Phone/Fax

Practice location:
  • Phone: 703-876-0437
  • Fax: 703-876-0722
Mailing address:
  • Phone: 703-876-0437
  • Fax: 703-876-0722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number0640228
License Number StateVA

VIII. Authorized Official

Name: DR. STAFFORD S GOLDSTEIN
Title or Position: SENIOR PARTNER
Credential: M.D.
Phone: 703-876-0437