Organization
LOUDOUN MEDICAL GROUP, PC
Active
Parent organization
LOUDOUN MEDICAL GROUP, PC
Other names
Loudoun Surgical
Organization subpart
Yes
Provider details
NPI number
Legal business name
LOUDOUN MEDICAL GROUP, PC
Authorized official
MARY BETH TAMASY (CEO)
(703) 737-6010
Entity
Organization
Contact information
Practice address
44055 RIVERSIDE PKWY, SUITE 102, LEESBURG, VA 20176-5179
(703) 858-3131
(703) 858-3130
Mailing address
PO BOX 17334, BALTIMORE, MD 21297-1334
(703) 443-6717
(703) 443-8643
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CG8678
RR MEDICARE PIN
VA
Enumeration date
03/19/2007
Last updated
08/18/2023
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