Healthcare Provider Details

I. General information

NPI: 1063667731
Provider Name (Legal Business Name): FALL HILL GASTROENTEROLOGY ENDOSCOPY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2008
Last Update Date: 11/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4103 LAFAYETTE BLVD
FREDERICKSBURG VA
22408-4274
US

IV. Provider business mailing address

4103 LAFAYETTE BLVD
FREDERICKSBURG VA
22408-4274
US

V. Phone/Fax

Practice location:
  • Phone: 540-371-9696
  • Fax:
Mailing address:
  • Phone: 540-371-9696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0800X
TaxonomyEndoscopy Clinic/Center
License Number
License Number StateVA

VIII. Authorized Official

Name: DR. THOMAS A MASTRI
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 540-371-9696