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NPI Code Detail

MEDICARE: THE GASTROENTEROLOGY GROUP, P.C.

MEDICARE: THE GASTROENTEROLOGY GROUP, P.C.
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
1207RG0100XGastroenterology Physician

General Provider Information

NPI Number : 1548358831
Entity Type Code : Organization
Provider Name (Legal Business Name) : THE GASTROENTEROLOGY GROUP, P.C.
Provider Business Mailing Address
First Line : 1939 ROLAND CLARKE PL STE 200
Second Line :
City : RESTON
State : VA
Zip : 20191-1445
Country : US
Telephone Number : 703-435-3366
Fax Number : 703-782-8833
Provider Business Practice Location Address
First Line : 1939 ROLAND CLARKE PL STE 200
Second Line :
City : RESTON
State : VA
Zip : 20191-1445
Country : US
Telephone Number : 703-435-3366
Fax Number : 703-782-8833
Authorized Official
Title or Position : OFFICE MANAGER
Name : MRS. PATRICIA DARLENE GLENN
Credential :
Telephone Number : 703-766-2650
Provider Enumeration Date : 10/11/2006
Last Update Date : 06/22/2021

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Directions to “THE GASTROENTEROLOGY GROUP, P.C. ” Practice Location

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