NPIMap

Organization Active NPI

Loudoun Medical Group, PC

Doing business as Loudoun Dermatology Associates

  • Dermatology Physician
  • Leesburg, VA
National Provider Identifier
1710001235
Registry record updated Apr 24, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
LOUDOUN MEDICAL GROUP, PC
Doing business as
Loudoun Dermatology Associates
Practice address
19415 Deerfield Avenue, Suite 314
Leesburg, VA 20176-8472
Phone
(703) 723-7171
Fax
(703) 723-7176
NPI assigned
Mar 19, 2007
Last updated
Apr 24, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
LOUDOUN MEDICAL GROUP, PCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 24, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X NU Primary

Addresses

Primary practice location

19415 Deerfield Avenue, Suite 314
Leesburg, VA 20176-8472

Mailing address

224-D Cornwall Street, NW, Suite 403
Leesburg, VA 20176-3346
Phone (703) 737-6010

Other identifiers 1

IdentifierTypeStateIssuer
CG8678OtherVARR MEDICARE PIN

Other names 1

  • Loudoun Dermatology Associates Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA

Enrollment records 1

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

Other NPIs on the same Medicare enrollment 25

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

View all 25

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
49D0943892Loudoun Dermatology Associates19415 Deerfield Avenue - Suite 314, Leesburg, VA 20176Provider-performed microscopyJan 23, 2027

National Provider Directory

National Provider Directory
Tax ID family
John M Archer MD305 organizations share this tax ID, including this one
Part of
John M Archer MD

Organizations with this tax ID in the same state 24

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 24

Locations

19415 Deerfield Ave
Ste 314
Leesburg, VA 20176
Phone (703) 723-7171

Ownership & related parties

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1174262400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1682294400000",
    "number": "1710001235",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "224-D CORNWALL STREET, NW, SUITE 403",
            "city": "LEESBURG",
            "state": "VA",
            "postal_code": "201763346",
            "telephone_number": "703-737-6010",
            "fax_number": "703-443-8643"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19415 DEERFIELD AVENUE, SUITE 314",
            "city": "LEESBURG",
            "state": "VA",
            "postal_code": "201768472",
            "telephone_number": "703-723-7171",
            "fax_number": "703-723-7176"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LOUDOUN MEDICAL GROUP, PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LOUDOUN MEDICAL GROUP, PC",
        "enumeration_date": "2007-03-19",
        "last_updated": "2023-04-24",
        "certification_date": "2023-04-24",
        "status": "A",
        "authorized_official_last_name": "TAMASY",
        "authorized_official_first_name": "MARY BETH",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "703-737-6010"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE PIN",
            "identifier": "CG8678",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Loudoun Dermatology Associates",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Loudoun Dermatology Associates",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Leesburg, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.