Healthcare Provider Details

I. General information

NPI: 1285994236
Provider Name (Legal Business Name): ANDREA DINA GROAG CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANDREA DINA WEISS CNM

II. Dates (important events)

Enumeration Date: 05/24/2012
Last Update Date: 03/11/2026
Certification Date: 03/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19450 DEERFIELD AVE STE 460
LEESBURG VA
20176-6840
US

IV. Provider business mailing address

8110 MAPLE LAWN BLVD STE 235
FULTON MD
20759-2694
US

V. Phone/Fax

Practice location:
  • Phone: 571-707-8522
  • Fax: 571-707-8577
Mailing address:
  • Phone: 301-340-8339
  • Fax: 301-340-9027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number0024185605
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberR200366
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: