Provider Demographics
NPI:1396770939
Name:NO VA GASTRO ASSOC LTD
Entity type:Organization
Organization Name:NO VA GASTRO ASSOC LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STAFFORD
Authorized Official - Middle Name:S
Authorized Official - Last Name:GOLDSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-876-0437
Mailing Address - Street 1:3301 WOODBURN ROAD
Mailing Address - Street 2:SUITE 107
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 ROAD
Practice Address - Street 2:SUITE 107
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:2006-07-12
Last Update Date:2008-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0640228174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA607568Medicare ID - Type Unspecified
VAPR0613370Medicare ID - Type Unspecified
VA612700Medicare PIN
VAC62789Medicare UPIN
VAE70218Medicare UPIN