Basic Information
Provider Information
NPI: 1790912566
EntityType: 2
ReplacementNPI:  
OrganizationName: GI ENDOSCOPY CENTER OF NORTHERN VIRGINIA
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Mailing Information
Address1: PO BOX 17334
Address2:  
City: BALTIMORE
State: MD
PostalCode: 212971334
CountryCode: US
TelephoneNumber: 7034436717
FaxNumber: 7034438643
Practice Location
Address1: 4660 KENMORE AVE
Address2: SUITE 100
City: ALEXANDRIA
State: VA
PostalCode: 223041313
CountryCode: US
TelephoneNumber: 7037515763
FaxNumber: 7033704655
Other Information
ProviderEnumerationDate: 06/18/2009
LastUpdateDate: 05/15/2013
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AuthorizedOfficialLastName: TAMASY
AuthorizedOfficialFirstName: MARY BETH
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AuthorizedOfficialTitleorPosition: CEO
AuthorizedOfficialTelephone: 7037376010
IsSoleProprietor:  
IsOrganizationSubpart: N
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Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
261QE0800X  Y Ambulatory Health Care FacilitiesClinic/CenterEndoscopy

No ID Information.


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