| Amanda Elizabeth Smart, | |
| 19415 Deerfield Avenue, Suite 112, Leesburg, VA 20176-8470 | |
| (703) 724-1195 | |
| (703) 724-4495 | 
| Full Name | Amanda Elizabeth Smart | 
|---|---|
| Gender | Female | 
| Speciality | Urology | 
| Location | 19415 Deerfield Avenue, Suite 112, Leesburg, Virginia | 
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. | 
| Identifier | Type | State | Issuer | 
|---|---|---|---|
| 1528520681 | NPI | - | NPPES | 
| 30018093910001 | Medicaid | VA | 
| Taxonomy | Type | License (State) | Status | 
|---|---|---|---|
| 208800000X | Urology | 0101279969 (Virginia) | Primary | 
| 390200000X | Student In An Organized Health Care Education/training Program | (* (Not Available)) | Secondary | 
| Entity Name | Loudoun Medical Group, Pc | 
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice | 
| Entity Identifiers | NPI Number: 1407908817 PECOS PAC ID: 0042119661 Enrollment ID: O20040102000616 | 
| Mailing Address | Practice Location Address | 
|---|---|
| Amanda Elizabeth Smart, 224-d Cornwall Street Nw, Suite 403, Leesburg, VA 20176-2704 Ph: (703) 737-6010 | Amanda Elizabeth Smart, 19415 Deerfield Avenue, Suite 112, Leesburg, VA 20176-8470 Ph: (703) 724-1195 | 
| Dr. Kyle Matthew Lester, D.O. Urology Medicare: Accepting Medicare Assignments Practice Location: 19415 Deerfield Avenue, Suite 112, Leesburg, VA 20176 Phone: 703-724-1195 | |
| Christine Ngoc Bich Tran, MD Urology Medicare: Accepting Medicare Assignments Practice Location: 19415 Deerfield Avenue, Suite 112, Leesburg, VA 20176 Phone: 703-724-1195 Fax: 703-724-4495 | |
| Chuck G Pruna, D.O. Urology Medicare: Accepting Medicare Assignments Practice Location: 19415 Deerfield Avenue, Suite 112, Leesburg, VA 20176 Phone: 703-724-1195 Fax: 703-724-4495 | |
| Gregory S Schenk, MD Urology Medicare: Accepting Medicare Assignments Practice Location: 19415 Deerfield Avenue, Suite 112, Leesburg, VA 20176 Phone: 703-724-1195 Fax: 703-724-4495 | |
| Kevin Paul O'connor, MD Urology Medicare: Accepting Medicare Assignments Practice Location: 19415 Deerfield Ave Ste 112, Leesburg, VA 20176 Phone: 703-724-1195 Fax: 703-724-4495 | |
| Dr. Walter M O'brien, MD Urology Medicare: Accepting Medicare Assignments Practice Location: 19415 Deerfield Avenue, Suite 112, Leesburg, VA 20176 Phone: 703-724-1195 Fax: 703-724-4495 |