Healthcare Provider Details

I. General information

NPI: 1639041627
Provider Name (Legal Business Name): NORTHERN VIRGINIA PEDIATRIC ORTHOPAEDICS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2025
Last Update Date: 09/22/2025
Certification Date: 09/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8316 ARLINGTON BLVD STE 500
FAIRFAX VA
22031-5216
US

IV. Provider business mailing address

1110 WESTBRIAR CT NE
VIENNA VA
22180-3665
US

V. Phone/Fax

Practice location:
  • Phone: 646-240-9444
  • Fax:
Mailing address:
  • Phone: 646-240-9444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. GEORGE DAMON GANTSOUDES
Title or Position: CHIEF MEDICAL DIRECTOR
Credential: MD
Phone: 571-306-1525