Healthcare Provider Details

I. General information

NPI: 1649138041
Provider Name (Legal Business Name): GASTROINTESTINAL SPECIALISTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2026
Last Update Date: 01/16/2026
Certification Date: 01/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19415 DEERFIELD AVE STE 112
LEESBURG VA
20176-8470
US

IV. Provider business mailing address

19415 DEERFIELD AVE STE 112
LEESBURG VA
20176-8470
US

V. Phone/Fax

Practice location:
  • Phone: 703-724-1195
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINE TRAN
Title or Position: AUTHORIZED
Credential:
Phone: 703-724-1195