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Individual

ANN I MA

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
224D CORNWALL ST NW, SUITE 207, LEESBURG, VA 20176-2700
(703) 771-9001
(703) 771-9076
Mailing address
224D CORNWALL ST NW, SUITE 207, LEESBURG, VA 20176-2700
(703) 771-9001
(703) 771-9076

Taxonomy

Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
00037326
MD
207RG0100X
Gastroenterology Physician
Primary
0101051491
VA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
203435
ANTHEM BCBS
VA
01
247336
UNITED HEALTHCARE MAMSI
Enumeration date
09/21/2006
Last updated
10/03/2013
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