Organization
LOUDOUN INTERNAL AND LIFESTYLE MEDICINE LLC
Active
Organization
LOUDOUN INTERNAL AND LIFESTYLE MEDICINE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GAUTHAMI GONDY MD (OWNER)
(703) 967-3863
Entity
Organization
Contact information
Practice address
19415 DEERFIELD AVE STE 210, LANSDOWNE, VA 20176-8471
(703) 967-3863
Mailing address
41187 GRENATA PRESERVE PL, LEESBURG, VA 20175-8716
(571) 600-1007
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Enumeration date
09/30/2019
Last updated
09/30/2019
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