Healthcare Provider Details

I. General information

NPI: 1821015561
Provider Name (Legal Business Name): TIMOTHY SCOTT MOUNTCASTLE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 12/13/2023
Certification Date: 12/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44095 PIPELINE PLAZA, SUITE 430
ASHBURN VA
20147-7519
US

IV. Provider business mailing address

224-D CORNWALL STREET, NW, SUITE 403
LEESBURG VA
20176-2704
US

V. Phone/Fax

Practice location:
  • Phone: 703-858-3208
  • Fax: 571-291-2289
Mailing address:
  • Phone: 703-737-6010
  • Fax: 703-443-8643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number0101239935
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number0101239935
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: