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General NPI Number Information
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NPI Number | 1629462171
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Entity Type | Organization
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Legal Business Name | ADVANCED DIGESTIVE CARE, LLC
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Dates
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Enumeration Date | 03/23/2015
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Last Update Date | 06/05/2023
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Provider Practice Location Address
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Address Line | 3301 WOODBURN RD STE 107
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City | ANNANDALE
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State | VA
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Zip | 22003-1297
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Country | US
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Telephone | 703-876-0437
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Fax | 703-876-0722
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Provider Business Mailing Address
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Address Line | 3301 WOODBURN RD STE 107
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City | ANNANDALE
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State | VA
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Zip | 22003-1297
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Country | US
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Telephone | 703-876-0437
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Fax | 703-876-0722
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MARTIN G PROSKY
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Credential | MD
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Telephone | 703-407-7216
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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Taxonomy #2
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Taxonomy Code | 207ZP0105X
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Taxonomy Name | Clinical Pathology/Laboratory Medicine Physician
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License Number |
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License Number State |
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