Healthcare Provider Details

I. General information

NPI: 1205884368
Provider Name (Legal Business Name): GASTROENTEROLOGY ASSOCIATES OF NORTHERN VIRGINIA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 05/15/2025
Certification Date: 05/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 JOSEPH SIEWICK DR. SUITE 308
FAIRFAX VA
22033-1739
US

IV. Provider business mailing address

3700 JOSEPH SIEWICK DR. SUITE 308
FAIRFAX VA
22033-1739
US

V. Phone/Fax

Practice location:
  • Phone: 703-716-8700
  • Fax: 703-716-8703
Mailing address:
  • Phone: 703-716-8700
  • Fax: 703-716-8703

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: ALAN OLIVER
Title or Position: CEO
Credential: CEO
Phone: 786-530-3820