Provider Demographics
NPI:1548358831
Name:THE GASTROENTEROLOGY GROUP, P.C.
Entity type:Organization
Organization Name:THE GASTROENTEROLOGY GROUP, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:DARLENE
Authorized Official - Last Name:GLENN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-766-2650
Mailing Address - Street 1:1939 ROLAND CLARKE PL STE 200
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20191-1445
Mailing Address - Country:US
Mailing Address - Phone:703-435-3366
Mailing Address - Fax:703-782-8833
Practice Address - Street 1:1939 ROLAND CLARKE PL STE 200
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20191-1445
Practice Address - Country:US
Practice Address - Phone:703-435-3366
Practice Address - Fax:703-782-8833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC62444Medicare UPIN
VAH43376Medicare UPIN
VAF79785Medicare UPIN
VAI47631Medicare UPIN
VAF28633Medicare UPIN
VAI23668Medicare UPIN