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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