| Loudoun Internal And Lifestyle Medicine Llc | |
|
19415 Deerfield Ave Ste 210 Lansdowne VA 20176-8471 | |
| (703) 967-3863 | |
| Not Available |
| Full Name | Loudoun Internal And Lifestyle Medicine Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 19415 Deerfield Ave Ste 210, Lansdowne, Virginia |
| Authorized Official Name and Position | Gauthami Gondy (OWNER) |
| Authorized Official Contact | 7039673863 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Loudoun Internal And Lifestyle Medicine Llc 41187 Grenata Preserve Pl Leesburg VA 20175-8716 Ph: (571) 600-1007 | Loudoun Internal And Lifestyle Medicine Llc 19415 Deerfield Ave Ste 210 Lansdowne VA 20176-8471 Ph: (703) 967-3863 |
| NPI Number | 1396386447 |
|---|---|
| Provider Enumeration Date | 09/30/2019 |
| Last Update Date | 09/30/2019 |
| Medicare PECOS PAC ID | 8921339094 |
|---|---|
| Medicare Enrollment ID | O20191004000726 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396386447 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Gauthami Gondy |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1992963144 PECOS PAC ID: 0143370544 Enrollment ID: I20090605000157 |
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