MEDICARE: DR. GEORGE DAMON GANTSOUDES MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207XP3100X	Pediatric Orthopaedic Surgery Physician	0101257854	VA
2	207X00000X	Orthopaedic Surgery Physician	0101257854	VA
3	207XP3100X	Pediatric Orthopaedic Surgery Physician	MD043693	DC

General Provider Information

NPI Number	:	1013173004
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GEORGE DAMON GANTSOUDES MD

Provider Business Mailing Address
First Line	:	3023 HAMAKER CT STE 500
Second Line	:
City	:	FAIRFAX
State	:	VA
Zip	:	22031-2241
Country	:	US
Telephone Number	:	703-876-2788
Fax Number	:

Provider Business Practice Location Address
First Line	:	410 MAPLE AVE W STE 5
Second Line	:
City	:	VIENNA
State	:	VA
Zip	:	22180-4224
Country	:	US
Telephone Number	:	646-240-9444
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/30/2008
Last Update Date	:	06/01/2026

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