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General NPI Number Information
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NPI Number | 1942440953
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Entity Type | Organization
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Legal Business Name | VIRGINIA OBSTETRICS & GYNECOLOGY PC
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Dates
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Enumeration Date | 03/03/2009
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Last Update Date | 03/03/2009
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Provider Practice Location Address
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Address Line | 44035 RIVERSIDE PKWY # 435
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City | LEESBURG
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State | VA
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Zip | 20176-8260
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Country | US
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Telephone | 703-858-5599
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Fax | 703-858-5699
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Provider Business Mailing Address
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Address Line | 44035 RIVERSIDE PKWY # 435
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City | LEESBURG
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State | VA
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Zip | 20176-8260
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Country | US
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Telephone | 703-858-5599
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Fax | 703-858-5699
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Authorized Official
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Title or Position | PRESIDENT AND CEO
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Name | DR. JACK PETE AYOUB
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Credential | M.D.
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Telephone | 703-858-5599
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 0101244378
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License Number State | VA
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