Provider Demographics
NPI:1467764886
Name:MIDDLEBURG GERIATRICS, PLC
Entity Type:Organization
Organization Name:MIDDLEBURG GERIATRICS, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:V
Authorized Official - Last Name:LISZKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-561-7204
Mailing Address - Street 1:24164 NEW MOUNTAIN ROAD
Mailing Address - Street 2:
Mailing Address - City:ALDIE
Mailing Address - State:VA
Mailing Address - Zip Code:20105-2167
Mailing Address - Country:US
Mailing Address - Phone:757-561-7204
Mailing Address - Fax:
Practice Address - Street 1:24430 MILLSTREAM DRIVE
Practice Address - Street 2:
Practice Address - City:ALDIE
Practice Address - State:VA
Practice Address - Zip Code:20105-3098
Practice Address - Country:US
Practice Address - Phone:757-561-6049
Practice Address - Fax:703-957-2388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-14
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty