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Organization

LOUDOUN ENDOSCOPY GROUP, LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
KRISTINA MATERNA (DIRECTOR, CREDENTIALING)
(901) 377-8219
Entity
Organization

Contact information

Practice address
19455 DEERFIELD AVE STE 212, LANSDOWNE, VA 20176-8102
(703) 724-9792
(703) 858-7310
Mailing address
ONE GI CREDENTIALING DEPARTMENT, PO BOX 381468, GERMANTOWN, TN 38183-1468

Taxonomy

Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
261QE0800X
Endoscopy Clinic/Center
Primary

Other

Enumeration date
11/24/2006
Last updated
02/03/2026
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