Provider Demographics
NPI:1497853303
Name:GASTROENTEROLOGY ASSOCIATES PLLC
Entity Type:Organization
Organization Name:GASTROENTEROLOGY ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:ANTONIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-771-9001
Mailing Address - Street 1:19500 SANDRIDGE WAY STE 470
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-3694
Mailing Address - Country:US
Mailing Address - Phone:703-771-9001
Mailing Address - Fax:703-771-9076
Practice Address - Street 1:19500 SANDRIDGE WAY STE 470
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-3694
Practice Address - Country:US
Practice Address - Phone:703-771-9001
Practice Address - Fax:703-771-9076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA203434OtherANTHEM BCBS
C09592Medicare ID - Type Unspecified