Organization
NMG AFFILIATE PRACTICE I, LLC
Active
Other names
Novant Health UVA Health System Lake Manassas OB/GYN
Organization subpart
No
Provider details
NPI number
Authorized official
GEOFFREY K GARDNER (VP OF FINANCE)
(571) 261-3529
Entity
Organization
Contact information
Practice address
25055 RIDING PLZ, SUITE 230, SOUTH RIDING, VA 20152-5917
(703) 361-3551
(703) 365-7702
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
(703) 361-3551
(703) 365-7702
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1922449263
—
VA
Enumeration date
07/16/2013
Last updated
04/06/2016
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