MEDICARE: GASTROENTEROLOGY ASSOCIATES VA, LLC

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	207RG0100X	Gastroenterology Physician	0101027526	VA

General Provider Information

NPI Number	:	1518990472
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GASTROENTEROLOGY ASSOCIATES VA, LLC

Provider Business Mailing Address
First Line	:	PO BOX 381468
Second Line	:
City	:	GERMANTOWN
State	:	TN
Zip	:	38183-1468
Country	:	US
Telephone Number	:
Fax Number	:	901-328-1355

Provider Business Practice Location Address
First Line	:	7915 LAKE MANASSAS DR STE 302
Second Line	:
City	:	GAINESVILLE
State	:	VA
Zip	:	20155-3260
Country	:	US
Telephone Number	:	571-248-0653
Fax Number	:	571-248-0658

Authorized Official
Title or Position	:	DIRECTOR, CREDENTIALING
Name	:	KRISTINA MATERNA
Credential	:
Telephone Number	:	901-377-8219

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	02/03/2026

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