Organization
LOUDOUN MEDICAL GROUP, PC
Active
Parent organization
LOUDOUN MEDICAL GROUP, PC
Other names
Loudoun Dermatology Associates
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
19415 DEERFIELD AVENUE, SUITE 314, LEESBURG, VA 20176-8472
(703) 723-7171
(703) 723-7176
Mailing address
224-D CORNWALL STREET, NW, SUITE 403, LEESBURG, VA 20176-3346
(703) 737-6010
(703) 443-8643
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CG8678
RR MEDICARE PIN
VA
Enumeration date
03/19/2007
Last updated
04/24/2023
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