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General NPI Number Information
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NPI Number | 1801962741
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Entity Type | Organization
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Legal Business Name | LOUDOUN ENDOSCOPY GROUP, LLC
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Dates
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Enumeration Date | 11/24/2006
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Last Update Date | 02/03/2026
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Provider Practice Location Address
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Address Line | 19455 DEERFIELD AVE STE 212
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City | LANSDOWNE
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State | VA
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Zip | 20176-8102
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Country | US
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Telephone | 703-724-9792
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Fax | 703-858-7310
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Provider Business Mailing Address
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Address Line | ONE GI CREDENTIALING DEPARTMENT PO BOX 381468
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City | GERMANTOWN
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State | TN
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Zip | 38183-1468
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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 | DIRECTOR, CREDENTIALING
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Name | KRISTINA MATERNA
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Credential |
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Telephone | 901-377-8219
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QE0800X
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Taxonomy Name | Endoscopy Clinic/Center
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License Number |
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License Number State |
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