Healthcare Provider Details

I. General information

NPI: 1013951326
Provider Name (Legal Business Name): LOUDOUN ENT & ALLERGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19455 DEERFIELD AVE SUITE 312
LANSDOWNE VA
20176-8446
US

IV. Provider business mailing address

19455 DEERFIELD AVE SUITE 312
LANSDOWNE VA
20176-8446
US

V. Phone/Fax

Practice location:
  • Phone: 703-858-0303
  • Fax:
Mailing address:
  • Phone: 703-858-0303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number0101238286
License Number StateVA

VIII. Authorized Official

Name: DR. SUMEET MATHUR
Title or Position: PRESIDENT
Credential: MD
Phone: 703-858-0303