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Organization

LOUDOUN MEDICAL GROUP, PC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MARY BETH TAMASY (CEO)
(703) 737-6010
Entity
Organization

Contact information

Practice address
224D CORNWALL ST NW, SUITE 403, LEESBURG, VA 20176-2700
(703) 737-6010
(703) 443-8643
Mailing address
PO BOX 17334, BALTIMORE, MD 21297-1334
(703) 443-6717
(703) 443-8643

Taxonomy

Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
207Q00000X
Family Medicine Physician
207QS1201X
Sleep Medicine (Family Medicine) Physician
207R00000X
Internal Medicine Physician
Primary
207RI0200X
Infectious Disease Physician
207V00000X
Obstetrics & Gynecology Physician
207VG0400X
Gynecology Physician
207X00000X
Orthopaedic Surgery Physician
207Y00000X
Otolaryngology Physician
208000000X
Pediatrics Physician
2080P0206X
Pediatric Gastroenterology Physician
208100000X
Physical Medicine & Rehabilitation Physician
2085R0001X
Radiation Oncology Physician
208600000X
Surgery Physician
208800000X
Urology Physician

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
CG8678
RR MEDICARE GROUP
VA
01
CG8679
RRMEDICARE
DC
01
CG8680
RR MEDICARE DC
DC
01
EC2891
RR MEDICARE PTAN 2023
VA
Enumeration date
07/18/2006
Last updated
08/18/2023
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