Provider Demographics
NPI:1568508414
Name:GASTROENTEROLOY ASSOCIATES OF NORTHERN VIRGINIA, LTD.
Entity Type:Organization
Organization Name:GASTROENTEROLOY ASSOCIATES OF NORTHERN VIRGINIA, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SNIVELY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-716-8700
Mailing Address - Street 1:12 EAST 86TH ST.
Mailing Address - Street 2:STE. 1008
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3022 WILLIAMS DR
Practice Address - Street 2:STE. 301
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4600
Practice Address - Country:US
Practice Address - Phone:703-698-9860
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY226194174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty