LOUDOUN MEDICAL GROUP PC (NPI# 1912183294) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1912183294 |
| Entity Type | Organization |
| Organization Name | LOUDOUN MEDICAL GROUP PC |
| Other Organization Name | MATTHEW B. GAVIN, MD |
| Practice Address |
224 D Cornwall Street Nw Suite 204 Leesburg VA 20176 |
| Mailing Address |
Po Box 17334 Baltimore MD 21297-1334 |
| Practice Telephone | 7037773262 |
| Practice Fax Number | 7037773365 |
| Mailing Telephone | 7034436717 |
| Mailing Fax Number | 7034438643 |
| Enumeration Date | 2008-01-16 |
| Last Update Date | 2019-05-22 |
| Authorized Official Name | MARY BETH TAMASY (CEO) |
| Authorized Official Telephone | 7037376010 |
| Is Organization Subpart | Y |
| Parent Organization Name | LOUDOUN MEDICAL GROUP PC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207X00000X | Orthopaedic Surgery | 0101043432 | VA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| VA | RR MEDICARE GROUP PIN | CG8678 | 01 |
| Other Name | Type Code |
|---|---|
| Matthew B. Gavin, MD | Doing Business As Name - Organization |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 19450 Deerfield Ave Ste 200, Leesburg, VA 201766821 | 7037773262 | 7037773365 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891217857 | Loudoun Medical Group PC | Obstetrics & Gynecology | 3301 Woodburn Rd Ste 309, Annandale, VA 22003-7308 | 2017-07-12 |
| 1487107587 | Loudoun Medical Group PC | Specialist | 6355 Walker Ln Ste 303, Suite 303, Alexandria, VA 22310-3247 | 2016-07-26 |
| 1184077976 | Loudoun Medical Group PC | Ophthalmology | 1901 N Beauregard St, Suite 100, Alexandria, VA 22311-1738 | 2016-07-18 |
| 1659728889 | Loudoun Medical Group PC | Urology | 24430 Stone Springs Blvd, Suite 100, Dulles, VA 20166-2247 | 2016-05-18 |
| 1285093070 | Loudoun Medical Group PC | Obstetrics & Gynecology | 8292 Old Courthouse Rd, Suite C, Vienna, VA 22182-3834 | 2016-02-22 |
| 1841658499 | Loudoun Medical Group PC | Internal Medicine | 10200 Colvin Run Rd, Suite 326, Great Falls, VA 22066-1830 | 2016-02-10 |
| 1114303922 | Loudoun Medical Group PC | Surgery | 19415 Deerfield Ave Ste 213, Lansdowne, VA 20176-8471 | 2015-08-04 |
| 1285021345 | Loudoun Medical Group PC | Ophthalmology | 8751 Sudley Rd, 2nd Floor, Manassas, VA 20110-8319 | 2015-04-16 |
| 1821409590 | Loudoun Medical Group PC | Internal Medicine | 3687 Fettler Park Dr, Dumfries, VA 22025-2049 | 2014-05-15 |
| 1134530900 | Loudoun Medical Group PC | Internal Medicine | 4897 Prince William Pkwy, Suite C 102, Woodbridge, VA 22192-5432 | 2014-05-15 |
| Street Address |
224 D CORNWALL STREET NW SUITE 204 |
| City | LEESBURG |
| State | VA |
| Zip Code | 20176 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346342565 | James Ticknor Gable | Orthopaedic Surgery | 224 D Cornwall Street Nw, Suite 204, Leesburg, VA 20176-4407 | 2006-09-01 |
| 1164698999 | Loudoun Medical Group PC | Orthopaedic Surgery | 224 D Cornwall Street Nw, Suite 204, Leesburg, VA 20176 | 2008-05-01 |
| 1619143443 | Loudoun Medical Group PC | Physical Medicine & Rehabilitation | 224 D Cornwall Street Nw, Suite 202, Leesburg, VA 20176 | 2008-05-01 |
| 1679759039 | Loudoun Medical Group PC | Urology | 224 D Cornwall Street Nw, Suite 400, Leesburg, VA 20176 | 2008-01-16 |
| 1083890404 | Loudoun Medical Group PC | Pediatrics | 224 D Cornwall Street Nw, Suite 104, Leesburg, VA 20176 | 2008-01-16 |
| 1528244951 | Loudoun Medical Group PC | Family Medicine | 224 D Cornwall Street Nw, Suite106, Leesburg, VA 20176 | 2008-01-16 |
| 1831375294 | Loudoun Medical Group PC | Otolaryngology | 224 D Cornwall Street Nw, Suite 306, Leesburg, VA 20176 | 2008-01-16 |
| 1194901512 | Loudoun Medical Group PC | Internal Medicine | 224 D Cornwall Street Nw, Suite 102, Leesburg, VA 20176 | 2008-01-16 |
| 1740466028 | Loudoun Medical Group PC | Orthopaedic Surgery | 224 D Cornwall Street Nw, Suite 204, Leesburg, VA 20176 | 2008-01-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053912923 | Timothy Michael Nixon | Pharmacist | 61 Catoctin Circle, Leesburg, VA 20176 | 2020-11-05 |
| 1558996645 | Stacey E Moran | Occupational Therapist | 44124 Woodrige Parkway, Lansdowne, VA 20176 | 2020-03-09 |
| 1710531272 | Joseph H Kasuska Jr. | Specialist/Technologist | 19455 Deerfield Ave. Suite 306, Lansdowne, VA 20176 | 2019-08-01 |
| 1568935849 | Joel Manalang Polintan Jr. | Physical Therapist | 171 Cedarwalk Circle, Leesburg, VA 20176 | 2019-01-09 |
| 1194203026 | Jing Cao | Acupuncturist | 19450 Deerfield Ave Ste 275, Leesburg, VA 20176 | 2018-08-02 |
| 1134648314 | Alaina Marie Gotwalt | Speech-Language Pathologist | 43850 Heatherstone Terrace, Unit 406, Leesburg, VA 20176 | 2017-09-19 |
| 1841717105 | Happy Inhome Care Corp | Respite Care | 722 E Market St Ste 103, Leesburg, VA 20176 | 2017-08-28 |
| 1912423484 | Aaa Good Healthcare LLC | Nursing Care | 722 East Market Street Ne, Suite 102, Leesburg, VA 20176 | 2017-08-16 |
| 1740704253 | Anna Maria Domingo Seaford | Physician Assistant | 19441 Golf Vista Plz Ste 230, Lansdowne, VA 20176 | 2017-07-27 |
| 1710436480 | Reena Patel | Physician Assistant | 224 Cornwall St Nw Leesburg Orthope, Unit 204, Leesburg, VA 20176 | 2016-09-23 |
| Find all providers in zip 20176 | ||||
| Taxonomy Code | 207X00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Orthopaedic Surgery |
| An orthopaedic surgeon is trained in the preservation, investigation and restoration of the form and function of the extremities, spine and associated structures by medical, surgical and physical means. An orthopaedic surgeon is involved with the care of patients whose musculoskeletal problems include congenital deformities, trauma, infections, tumors, metabolic disturbances of the musculoskeletal system, deformities, injuries and degenerative diseases of the spine, hands, feet, knee, hip, shoulder and elbow in children and adults. An orthopaedic surgeon is also concerned with primary and secondary muscular problems and the effects of central or peripheral nervous system lesions of the musculoskeletal system. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Orthopaedic Surgery, 2007. http://www.abos.org/. American Osteopathic Board of Orthopaedic Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Orthopaedic Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Orthopaedic Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992318067 | Loudoun Medical Group . P.c | Orthopaedic Surgery | 224d Cornwall St Nw Ste 403, Leesburg, VA 20176-2704 | 2020-08-28 |
| 1093324378 | Loudoun Medical Group . P.c | Orthopaedic Surgery | 19450 Deefield Avenue, Suite 200, Leesburg, VA 20176-2017 | 2020-07-23 |
| 1750999892 | Loudoun Medical Group . P.c | Orthopaedic Surgery | 224d Cornwall St Nw Ste 230, Leesburg, VA 20176-2704 | 2020-07-15 |
| 1184137242 | K2m, Inc. | Orthopaedic Surgery | K2m, Inc., 600 Hope Parkway Se, Leesburg, VA 20175 | 2017-11-13 |
| 1689082208 | Peter Melcher | Orthopaedic Surgery | 4646 Summerbridge Cir, Leesburg, FL 34748-7486 | 2014-07-28 |
| 1629192141 | Loudoun Medical Group PC | Orthopaedic Surgery | 19 Fort Evans Rd Ne Ste C, Leesburg, VA 20176-4487 | 2007-03-19 |
| 1790811370 | George P Rowan | Orthopaedic Surgery | 18419 Rim Rock Cir, Leesburg, VA 20176-6832 | 2007-02-26 |
| 1346342565 | James Ticknor Gable | Orthopaedic Surgery | 224 D Cornwall Street Nw, Suite 204, Leesburg, VA 20176-4407 | 2006-09-01 |
| 1538194345 | Claudia L Thomas | Orthopaedic Surgery | 701 Medical Plaza Dr, Leesburg, FL 34748-7313 | 2006-07-11 |
| 1588655740 | Michael Andrew Kavanagh | Orthopaedic Surgery | 224d Cornwall St Nw Ste 204, Leesburg, VA 20176-2700 | 2005-11-04 |
| Find all providers in LEESBURG | ||||
Please comment or provide details below to improve the information on LOUDOUN MEDICAL GROUP PC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.