NPIMap

Loudoun Medical Group, PC

Organization Active NPI Surgery Physician · Leesburg, VA

NPI 1689798175 · NPPES record last updated Aug 18, 2023

Key facts

NPI
1689798175
Entity type
Organization (NPI type 2)
Primary specialty
Surgery Physician 208600000X
Legal business name
LOUDOUN MEDICAL GROUP, PC
Practice address
44055 Riverside Pkwy
Suite 102
Leesburg, VA 20176-5179
Phone
(703) 858-3131
Fax
(703) 858-3130
NPI assigned
Mar 19, 2007
Organization subpart
Yes
Parent organization (as reported)
LOUDOUN MEDICAL GROUP, PC

Authorized official

Name
Mary Beth Tamasy
Title
Ceo
Phone
(703) 737-6010

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Other NPIs on the same Medicare enrollment 25

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Corporate family (same tax ID) 24

Organizations that report the same tax identification number in the National Provider Directory.

Medicare participation

Medicare fee-for-service enrollment
Enrolled in VA

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20041115000474 VA Part B Supplier - Clinic/Group Practice 0042119661 Receives reassigned benefits from 340 practitioners
32 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment

National Provider Directory

Tax ID family
Walter M Obrien MD (305 organizations share this tax ID)
Part of
Walter M Obrien MD

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician
Group: 193400000X SINGLE SPECIALTY GROUP		 208600000X Yes

Addresses

Primary practice location

44055 Riverside Pkwy
Suite 102
Leesburg, VA 20176-5179

Mailing address

PO Box 17334
Baltimore, MD 21297-1334
Phone (703) 443-6717

Other identifiers

IdentifierTypeStateIssuer
CG8678OtherVARR MEDICARE PIN

Other names

  • Loudoun Surgical Doing business as

Other providers in Leesburg, VA

All providers in Leesburg, VA · Surgery Physician in Virginia

Sources for this page

Verify at the official NPI Registry.