MEDICARE: NORTHERN VIRGINIA GASTROENTEROLOGY, PC

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	174400000X	Specialist	0101055991	VA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	001014	OTHER	VA	MEDICARE MIN

General Provider Information

NPI Number	:	1366748634
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHERN VIRGINIA GASTROENTEROLOGY, PC

Provider Business Mailing Address
First Line	:	46169 WESTLAKE DR STE 200
Second Line	:
City	:	STERLING
State	:	VA
Zip	:	20165-5875
Country	:	US
Telephone Number	:	703-378-1734
Fax Number	:	703-378-1735

Provider Business Practice Location Address
First Line	:	46169 WESTLAKE DR STE 200
Second Line	:
City	:	STERLING
State	:	VA
Zip	:	20165-5875
Country	:	US
Telephone Number	:	703-378-1734
Fax Number	:	703-378-1735

Authorized Official
Title or Position	:	PRESIDENT
Name	:	NISHA CHAND
Credential	:	MD
Telephone Number	:	703-378-1734

Provider Enumeration Date	:	02/04/2011
Last Update Date	:	03/03/2026

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