Provider Demographics
NPI:1396386447
Name:LOUDOUN INTERNAL AND LIFESTYLE MEDICINE LLC
Entity Type:Organization
Organization Name:LOUDOUN INTERNAL AND LIFESTYLE MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GAUTHAMI
Authorized Official - Middle Name:
Authorized Official - Last Name:GONDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-967-3863
Mailing Address - Street 1:41187 GRENATA PRESERVE PL
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20175-8716
Mailing Address - Country:US
Mailing Address - Phone:571-600-1007
Mailing Address - Fax:
Practice Address - Street 1:19415 DEERFIELD AVE STE 210
Practice Address - Street 2:
Practice Address - City:LANSDOWNE
Practice Address - State:VA
Practice Address - Zip Code:20176-8471
Practice Address - Country:US
Practice Address - Phone:703-967-3863
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-30
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty