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General NPI Number Information
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NPI Number | 1013951326
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Entity Type | Organization
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Legal Business Name | LOUDOUN ENT & ALLERGY
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Dates
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Enumeration Date | 06/16/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 19455 DEERFIELD AVE SUITE 312
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City | LANSDOWNE
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State | VA
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Zip | 20176-8446
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Country | US
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Telephone | 703-858-0303
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Fax |
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Provider Business Mailing Address
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Address Line | 19455 DEERFIELD AVE SUITE 312
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City | LANSDOWNE
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State | VA
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Zip | 20176-8446
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Country | US
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Telephone | 703-858-0303
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SUMEET MATHUR
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Credential | MD
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Telephone | 703-858-0303
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207YS0123X
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Taxonomy Name | Facial Plastic Surgery Physician
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License Number | 0101238286
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License Number State | VA
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