Provider Demographics
NPI:1881634053
Name:GASTROENTEROLOGY CONSULTANTS OF NORTHERN VIRGINIA PLC
Entity Type:Organization
Organization Name:GASTROENTEROLOGY CONSULTANTS OF NORTHERN VIRGINIA PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:JUN
Authorized Official - Last Name:HUH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-262-0200
Mailing Address - Street 1:4001 FAIR RIDGE DR
Mailing Address - Street 2:#206
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-2917
Mailing Address - Country:US
Mailing Address - Phone:703-262-0200
Mailing Address - Fax:703-262-0211
Practice Address - Street 1:4001 FAIR RIDGE DR
Practice Address - Street 2:#206
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-2917
Practice Address - Country:US
Practice Address - Phone:703-262-0200
Practice Address - Fax:703-262-0211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-07
Last Update Date:2010-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101232518207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAH61604Medicare UPIN
VAG01735Medicare ID - Type Unspecified