Provider Demographics
NPI:1750429213
Name:METROPOLITAN LIVER DISEASES GASTROENTEROLOGY CENTER
Entity type:Organization
Organization Name:METROPOLITAN LIVER DISEASES GASTROENTEROLOGY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VINOD
Authorized Official - Middle Name:KUMAR
Authorized Official - Last Name:RUSTGI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-698-9254
Mailing Address - Street 1:8316 ARLINGTON BLVD
Mailing Address - Street 2:SUITE 515
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-5207
Mailing Address - Country:US
Mailing Address - Phone:703-698-9254
Mailing Address - Fax:703-698-9256
Practice Address - Street 1:8316 ARLINGTON BLVD
Practice Address - Street 2:SUITE 515
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-5207
Practice Address - Country:US
Practice Address - Phone:703-698-9254
Practice Address - Fax:703-698-9256
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-04
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA33131207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DA7118OtherRAILROAD MEDICARE
VAB09574Medicare UPIN
G00891Medicare PIN