NPI Code Detail JSON Logo

1639041627 NPI number — NORTHERN VIRGINIA PEDIATRIC ORTHOPAEDICS PLLC

NPI Number: 1639041627
Health Care Provider/Practitioner: NORTHERN VIRGINIA PEDIATRIC ORTHOPAEDICS PLLC

Information about “1639041627” NPI (NORTHERN VIRGINIA PEDIATRIC ORTHOPAEDICS PLLC) exists in 1639041627 in HTML format HTML  |  1639041627 in plain Text format TXT  |  1639041627 in PDF (Portable Document Format) PDF  |  1639041627 in an XML format XML  formats.

NPI Number : 1639041627 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1639041627",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "NORTHERN VIRGINIA PEDIATRIC ORTHOPAEDICS PLLC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1110 WESTBRIAR CT NE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "VIENNA",
    "MailingAddressStateName": "VA",
    "MailingAddressPostalCode": "22180-3665",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "646-240-9444",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "8316 ARLINGTON BLVD STE 500",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "FAIRFAX",
    "PracticeLocationAddressStateName": "VA",
    "PracticeLocationAddressPostalCode": "22031-5216",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "646-240-9444",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "09/19/2025",
    "LastUpdateDate": "09/22/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "GANTSOUDES",
    "AuthorizedOfficialFirstName": "GEORGE",
    "AuthorizedOfficialMiddleName": "DAMON",
    "AuthorizedOfficialTitle": "CHIEF MEDICAL DIRECTOR",
    "AuthorizedOfficialNamePrefix": "DR.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "MD",
    "AuthorizedOfficialTelephoneNumber": "571-306-1525",
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "261QX0100X",
          "TaxonomyName": "Occupational Medicine Clinic/Center",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "261QR0200X",
          "TaxonomyName": "Radiology Clinic/Center",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "261QP2000X",
          "TaxonomyName": "Physical Therapy Clinic/Center",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "207XP3100X",
          "TaxonomyName": "Pediatric Orthopaedic Surgery Physician",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY  GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
      }
    }
  }
}
                
            

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