Provider Demographics
NPI:1376565234
Name:NORTHERN VIRGINIA PODIATRY GROUP, P.C.
Entity Type:Organization
Organization Name:NORTHERN VIRGINIA PODIATRY GROUP, P.C.
Other - Org Name:LANSDOWNE FOOT & ANKLE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:KUGLER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:703-885-7887
Mailing Address - Street 1:19440 GOLF VISTA PLZ
Mailing Address - Street 2:SUITE 120
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-8263
Mailing Address - Country:US
Mailing Address - Phone:703-858-7887
Mailing Address - Fax:703-858-7453
Practice Address - Street 1:19440 GOLF VISTA PLZ
Practice Address - Street 2:SUITE 120
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-8263
Practice Address - Country:US
Practice Address - Phone:703-858-7887
Practice Address - Fax:703-858-7453
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LANSDOWNE FOOT AND ANKLE CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-23
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA178242Medicare PIN
VAC08936Medicare ID - Type UnspecifiedTRAILBLAZER MEDICARE VA
VA4940330001Medicare NSC