Provider Demographics
NPI:1700935053
Name:ADVANCED SURGERY OF ALEXANDRIA PC
Entity Type:Organization
Organization Name:ADVANCED SURGERY OF ALEXANDRIA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:KEVIN
Authorized Official - Last Name:GILLIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-313-8808
Mailing Address - Street 1:PO BOX 7004
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22307-0004
Mailing Address - Country:US
Mailing Address - Phone:703-313-8808
Mailing Address - Fax:703-313-8850
Practice Address - Street 1:8988 LORTON STATION BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:LORTON
Practice Address - State:VA
Practice Address - Zip Code:22079-4733
Practice Address - Country:US
Practice Address - Phone:703-313-8808
Practice Address - Fax:703-313-8850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAG01034Medicare PIN
VADA8027Medicare PIN