Provider Demographics
NPI:1750500724
Name:DIGESTIVE DISEASE PHYSICIANS, P.C.
Entity type:Organization
Organization Name:DIGESTIVE DISEASE PHYSICIANS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:S
Authorized Official - Last Name:PETERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-751-5763
Mailing Address - Street 1:4660 KENMORE AVE
Mailing Address - Street 2:SUITE #305
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-1313
Mailing Address - Country:US
Mailing Address - Phone:703-751-5763
Mailing Address - Fax:703-370-8704
Practice Address - Street 1:4660 KENMORE AVE
Practice Address - Street 2:SUITE #305
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-1313
Practice Address - Country:US
Practice Address - Phone:703-751-5763
Practice Address - Fax:703-370-8704
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6079954Medicaid
VA6079954Medicaid
VAC87770Medicare UPIN