Provider Demographics
NPI:1396040986
Name:LOUDOUN MEDICAL GROUP CHARITABLE FOUNDATION
Entity Type:Organization
Organization Name:LOUDOUN MEDICAL GROUP CHARITABLE FOUNDATION
Other - Org Name:IFMC FOUNDATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARY BETH
Authorized Official - Middle Name:
Authorized Official - Last Name:TAMASY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-737-6010
Mailing Address - Street 1:116Q EDWARDS FERRY RD NE
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-2301
Mailing Address - Country:US
Mailing Address - Phone:703-669-6118
Mailing Address - Fax:703-669-6996
Practice Address - Street 1:116Q EDWARDS FERRY RD NE
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-2301
Practice Address - Country:US
Practice Address - Phone:703-669-6118
Practice Address - Fax:703-669-6996
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LOUDOUN MEDICAL GROUP CHARITABLE FOUNDATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-01-13
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty