Provider Demographics
NPI:1154546158
Name:GASTROENTEROLOGY CENTER OF NORTHERN VIRGINIA LTD
Entity type:Organization
Organization Name:GASTROENTEROLOGY CENTER OF NORTHERN VIRGINIA LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GABRIEL
Authorized Official - Middle Name:B
Authorized Official - Last Name:HERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-560-6106
Mailing Address - Street 1:3299 WOODBURN ROAD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003
Mailing Address - Country:US
Mailing Address - Phone:703-560-6106
Mailing Address - Fax:703-204-1968
Practice Address - Street 1:3299 WOODBURN ROAD
Practice Address - Street 2:SUITE 220
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003
Practice Address - Country:US
Practice Address - Phone:703-560-6106
Practice Address - Fax:703-204-1968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2013-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA123069Medicare ID - Type UnspecifiedBILLING PROVIDER NUMBER