NPIMap

Organization Active NPI

Loudoun Medical Group, PC

Doing business as Matthew B Gavin

  • Specialist
  • Dulles, VA
National Provider Identifier
1912449042
Registry record updated Aug 18, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
LOUDOUN MEDICAL GROUP, PC
Doing business as
Matthew B Gavin
Practice address
24430 Stone Springs Blvd
Suite 100
Dulles, VA 20166-2247
Phone
(703) 777-3262
Fax
(703) 777-3365
NPI assigned
Nov 7, 2016
Last updated
Aug 18, 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 Aug 18, 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) 737-6012

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193200000X MULTI-SPECIALTY GROUP 174400000X Primary

Addresses

Primary practice location

24430 Stone Springs Blvd
Suite 100
Dulles, VA 20166-2247

Mailing address

224D Cornwall St NW
Suite 403
Leesburg, VA 20176-2700
Phone (703) 737-6012

Other names 1

  • MATTHEW B GAVIN Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Loudoun Medical Group P305 organizations share this tax ID, including this one
Part of
Loudoun Medical Group P

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

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": "1478476800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1692316800000",
    "number": "1912449042",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "224D CORNWALL ST NW",
            "address_2": "SUITE 403",
            "city": "LEESBURG",
            "state": "VA",
            "postal_code": "201762700",
            "telephone_number": "703-737-6012"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24430 STONE SPRINGS BLVD",
            "address_2": "SUITE 100",
            "city": "DULLES",
            "state": "VA",
            "postal_code": "201662247",
            "telephone_number": "703-777-3262",
            "fax_number": "703-777-3365"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LOUDOUN MEDICAL GROUP, PC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LOUDOUN MEDICAL GROUP, PC",
        "enumeration_date": "2016-11-07",
        "last_updated": "2023-08-18",
        "certification_date": "2023-08-18",
        "status": "A",
        "authorized_official_last_name": "TAMASY",
        "authorized_official_first_name": "MARY BETH",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "703-737-6012"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MATTHEW B GAVIN",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "MATTHEW B GAVIN",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Dulles, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 18, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.