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General NPI Number Information
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NPI Number | 1639041627
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Entity Type | Organization
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Legal Business Name | NORTHERN VIRGINIA PEDIATRIC ORTHOPAEDICS PLLC
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Dates
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Enumeration Date | 09/19/2025
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Last Update Date | 09/22/2025
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Provider Practice Location Address
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Address Line | 8316 ARLINGTON BLVD STE 500
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City | FAIRFAX
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State | VA
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Zip | 22031-5216
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Country | US
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Telephone | 646-240-9444
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Fax |
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Provider Business Mailing Address
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Address Line | 1110 WESTBRIAR CT NE
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City | VIENNA
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State | VA
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Zip | 22180-3665
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Country | US
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Telephone | 646-240-9444
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Fax |
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Authorized Official
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Title or Position | CHIEF MEDICAL DIRECTOR
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Name | DR. GEORGE DAMON GANTSOUDES
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Credential | MD
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Telephone | 571-306-1525
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QX0100X
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Taxonomy Name | Occupational Medicine Clinic/Center
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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 | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QP2000X
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Taxonomy Name | Physical Therapy Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207XP3100X
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Taxonomy Name | Pediatric Orthopaedic Surgery Physician
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License Number |
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License Number State |
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