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General NPI Number Information
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NPI Number | 1184731796
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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 | 08/23/2006
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Last Update Date | 07/31/2020
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Provider Practice Location Address
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Address Line | 7430 HERITAGE VILLAGE PLAZA SUITE 101
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City | GAINESVILLE
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State | VA
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Zip | 20155
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Country | US
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Telephone | 703-753-3338
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Fax | 703-753-7870
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Provider Business Mailing Address
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Address Line | 7430 HERITAGE VILLAGE PLZ SUITE 101
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City | GAINESVILLE
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State | VA
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Zip | 20155-3088
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Country | US
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Telephone | 703-753-3338
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Fax | 703-753-7870
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Authorized Official
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Title or Position | PRESIDENT
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Name | MUKESH D. BHAKTA
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Credential | DPM
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Telephone | 703-753-3338
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number |
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License Number State |
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