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General NPI Number Information
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NPI Number | 1043334410
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Entity Type | Organization
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Legal Business Name | LOUDOUN MEDICAL GROUP, PC
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Dates
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Enumeration Date | 03/19/2007
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Last Update Date | 09/27/2022
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Provider Practice Location Address
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Address Line | 46165 WESTLAKE DR., STE 120
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City | POTOMAC FALLS
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State | VA
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Zip | 20165-5872
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Country | US
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Telephone | 703-444-3302
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Fax | 703-444-3240
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Provider Business Mailing Address
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Address Line | 224-D CORNWALL STREET, NW, SUITE 403
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City | LEESBURG
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State | VA
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Zip | 20176-2704
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Country | US
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Telephone | 703-737-6010
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Fax | 571-291-9786
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Authorized Official
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Title or Position | CEO
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Name | MARY BETH TAMASY
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Credential |
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Telephone | 703-737-6010
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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