Provider Demographics
NPI:1720111685
Name:LANSDOWNE INTERNAL MEDICINE LLC
Entity type:Organization
Organization Name:LANSDOWNE INTERNAL MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TINA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:LEACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-737-7622
Mailing Address - Street 1:224D CORNWALL ST NW
Mailing Address - Street 2:SUITE 302
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-2700
Mailing Address - Country:US
Mailing Address - Phone:703-737-7622
Mailing Address - Fax:703-723-7242
Practice Address - Street 1:224D CORNWALL ST NW
Practice Address - Street 2:SUITE 302
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-2700
Practice Address - Country:US
Practice Address - Phone:703-737-7622
Practice Address - Fax:703-723-7242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CK2977OtherMEDICARE RAILROAD
C08414Medicare ID - Type UnspecifiedGROUP