Provider Demographics
NPI:1205884368
Name:GASTROENTEROLOGY ASSOCIATES OF NORTHERN VIRGINIA, LLC
Entity type:Organization
Organization Name:GASTROENTEROLOGY ASSOCIATES OF NORTHERN VIRGINIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:OLIVER
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:786-530-3820
Mailing Address - Street 1:3700 JOSEPH SIEWICK DR.
Mailing Address - Street 2:SUITE 308
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-1739
Mailing Address - Country:US
Mailing Address - Phone:703-716-8700
Mailing Address - Fax:703-716-8703
Practice Address - Street 1:3700 JOSEPH SIEWICK DR.
Practice Address - Street 2:SUITE 308
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-1739
Practice Address - Country:US
Practice Address - Phone:703-716-8700
Practice Address - Fax:703-716-8703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty
No2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric GastroenterologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VACD8396OtherRAILROAD MEDICARE
VA3810003805Medicaid
VA178704OtherANTHEM BCBS
104411OtherKAISER
7916OtherCAREFIRST BCBS
VA178704OtherANTHEM BCBS