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General NPI Number Information
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NPI Number | 1790053171
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Entity Type | Organization
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Legal Business Name | LOUDOUN MEDICAL GROUP, PC
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Dates
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Enumeration Date | 12/13/2011
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Last Update Date | 08/18/2023
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Provider Practice Location Address
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Address Line | 19450 DEERFIELD AVE SUITE 175
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City | LEESBURG
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State | VA
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Zip | 20176-6820
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Country | US
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Telephone | 703-858-5454
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Fax | 703-858-4650
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Provider Business Mailing Address
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Address Line | PO BOX 17334
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City | BALTIMORE
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State | MD
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Zip | 21297-1334
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Country | US
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Telephone | 703-443-6717
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Fax | 703-443-8643
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Authorized Official
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Title or Position | CREDENTIALING COORDINATOR
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Name | MARY BETH TAMASY
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Credential |
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Telephone | 703-737-6010
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number |
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License Number State |
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