Provider Demographics
NPI:1417604000
Name:ADVANCE MEDICAL GI PC
Entity Type:Organization
Organization Name:ADVANCE MEDICAL GI PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BLOSSER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-281-1023
Mailing Address - Street 1:3975 FAIR RIDGE DR STE N300
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-2928
Mailing Address - Country:US
Mailing Address - Phone:702-766-2600
Mailing Address - Fax:
Practice Address - Street 1:3975 FAIR RIDGE DR STE N300
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-2928
Practice Address - Country:US
Practice Address - Phone:702-766-2600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-03
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty