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General NPI Number Information
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NPI Number | 1639355985
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Entity Type | Organization
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Legal Business Name | VIRGINIA GASTROENTEROLOGY & HEPATOLOGY, INC.
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Dates
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Enumeration Date | 01/17/2008
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Last Update Date | 02/13/2008
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Provider Practice Location Address
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Address Line | 9257 OLD KEENE MILL RD
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City | BURKE
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State | VA
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Zip | 22015-4202
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Country | US
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Telephone | 703-455-5556
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Fax |
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Provider Business Mailing Address
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Address Line | 9257 OLD KEENE MILL RD
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City | BURKE
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State | VA
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Zip | 22015-4202
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | CHARLES MCBRIDE
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Credential | M.D.
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Telephone | 703-455-5556
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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 | 0101047013
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License Number State | VA
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