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General NPI Number Information
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NPI Number | 1174110308
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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 | 12/22/2020
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Last Update Date | 09/02/2025
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Provider Practice Location Address
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Address Line | 224- D CORNWALL STREET, NW, SUITE 204
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City | LEESBURG
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State | VA
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Zip | 20176-2700
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Country | US
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Telephone | 703-925-5115
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Fax | 703-912-0425
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Provider Business Mailing Address
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Address Line | 224D CORNWALL ST NW STE 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 | 703-737-6012
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Fax |
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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 | 207XS0117X
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Taxonomy Name | Orthopaedic Surgery of the Spine Physician
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License Number |
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License Number State |
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