Provider Demographics
NPI:1629462171
Name:ADVANCED DIGESTIVE CARE, LLC
Entity Type:Organization
Organization Name:ADVANCED DIGESTIVE CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:G
Authorized Official - Last Name:PROSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-407-7216
Mailing Address - Street 1:3301 WOODBURN RD STE 107
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-1297
Mailing Address - Country:US
Mailing Address - Phone:703-876-0437
Mailing Address - Fax:703-876-0722
Practice Address - Street 1:3301 WOODBURN RD STE 107
Practice Address - Street 2:
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-1297
Practice Address - Country:US
Practice Address - Phone:703-876-0437
Practice Address - Fax:703-876-0722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-23
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory MedicineGroup - Multi-Specialty
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty