Provider Demographics
NPI:1417053323
Name:GREGORY M. KOONS, M.D.&ASSOCIATES,P.C.
Entity Type:Organization
Organization Name:GREGORY M. KOONS, M.D.&ASSOCIATES,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY TREASURER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JAN
Authorized Official - Middle Name:MARJORIE
Authorized Official - Last Name:KOONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-385-3220
Mailing Address - Street 1:3905 RAILROAD AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-3933
Mailing Address - Country:US
Mailing Address - Phone:703-385-3220
Mailing Address - Fax:703-691-0547
Practice Address - Street 1:3905 RAILROAD AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-3933
Practice Address - Country:US
Practice Address - Phone:703-385-3220
Practice Address - Fax:703-691-0547
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101027049207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G00220Medicare ID - Type Unspecified