Provider Demographics
NPI:1639041627
Name:NORTHERN VIRGINIA PEDIATRIC ORTHOPAEDICS PLLC
Entity type:Organization
Organization Name:NORTHERN VIRGINIA PEDIATRIC ORTHOPAEDICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:DAMON
Authorized Official - Last Name:GANTSOUDES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:571-306-1525
Mailing Address - Street 1:1110 WESTBRIAR CT NE
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22180-3665
Mailing Address - Country:US
Mailing Address - Phone:646-240-9444
Mailing Address - Fax:
Practice Address - Street 1:8316 ARLINGTON BLVD STE 500
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-5216
Practice Address - Country:US
Practice Address - Phone:646-240-9444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-19
Last Update Date:2025-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic SurgeryGroup - Single Specialty
No261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy