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4660 Kenmore Ave Ste 500 Alexandria VA 22304-1300 | |
| (703) 757-5763 | |
| (703) 370-8704 |
| Full Name | |
|---|---|
| Speciality | Internal Medicine - Gastroenterology |
| Location | 4660 Kenmore Ave Ste 500, Alexandria, Virginia |
| Authorized Official Name and Position | Mary Beth Tamasy (CEO) |
| Authorized Official Contact | 7037376010 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
224d Cornwall St Nw Ste 403 Leesburg VA 20176-2704 Ph: (703) 737-6010 | 4660 Kenmore Ave Ste 500 Alexandria VA 22304-1300 Ph: (703) 757-5763 |
| NPI Number | 1407464092 |
|---|---|
| Provider Enumeration Date | 07/20/2020 |
| Last Update Date | 09/16/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407464092 | NPI | - | NPPES |
| 1675951440 | Medicaid | VA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0100X | Internal Medicine - Gastroenterology | (* (Not Available)) | Primary |
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