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General NPI Number Information
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NPI Number | 1205884368
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Entity Type | Organization
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Legal Business Name | GASTROENTEROLOGY ASSOCIATES OF NORTHERN VIRGINIA, LLC
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Dates
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Enumeration Date | 05/04/2006
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Last Update Date | 05/15/2025
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Provider Practice Location Address
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Address Line | 3700 JOSEPH SIEWICK DR. SUITE 308
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City | FAIRFAX
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State | VA
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Zip | 22033-1739
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Country | US
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Telephone | 703-716-8700
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Fax | 703-716-8703
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Provider Business Mailing Address
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Address Line | 3700 JOSEPH SIEWICK DR. SUITE 308
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City | FAIRFAX
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State | VA
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Zip | 22033-1739
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Country | US
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Telephone | 703-716-8700
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Fax | 703-716-8703
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Authorized Official
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Title or Position | CEO
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Name | ALAN OLIVER
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Credential | CEO
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Telephone | 786-530-3820
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0206X
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Taxonomy Name | Pediatric Gastroenterology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number |
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License Number State |
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