| Advanced Digestive Care, Llc | |
|
3301 Woodburn Rd Ste 107 Annandale VA 22003-1297 | |
| (703) 876-0437 | |
| (703) 876-0722 |
| Full Name | Advanced Digestive Care, Llc |
|---|---|
| Speciality | Pathology |
| Location | 3301 Woodburn Rd Ste 107, Annandale, Virginia |
| Authorized Official Name and Position | Martin G Prosky (ADMINISTRATOR) |
| Authorized Official Contact | 7034077216 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Advanced Digestive Care, Llc 3301 Woodburn Rd Ste 107 Annandale VA 22003-1297 Ph: (703) 876-0437 | Advanced Digestive Care, Llc 3301 Woodburn Rd Ste 107 Annandale VA 22003-1297 Ph: (703) 876-0437 |
| NPI Number | 1629462171 |
|---|---|
| Provider Enumeration Date | 03/23/2015 |
| Last Update Date | 06/05/2023 |
| Medicare PECOS PAC ID | 3375857725 |
|---|---|
| Medicare Enrollment ID | O20170124002297 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629462171 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0100X | Internal Medicine - Gastroenterology | (* (Not Available)) | Secondary |
| 207ZP0105X | Pathology - Clinical Pathology/laboratory Medicine | (* (Not Available)) | Primary |
| Provider Name | Martin G Prosky |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1740215391 PECOS PAC ID: 0244240166 Enrollment ID: I20101116000069 |
| Provider Name | Srikrishna Vemana |
|---|---|
| Provider Type | Practitioner - Gastroenterology |
| Provider Identifiers | NPI Number: 1578771820 PECOS PAC ID: 5496947756 Enrollment ID: I20110808000202 |
| Provider Name | Katie Crain Zimmerman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639154099 PECOS PAC ID: 4385807395 Enrollment ID: I20150217000966 |
| Provider Name | Amy Peng |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1457926222 PECOS PAC ID: 9133651086 Enrollment ID: I20241016002187 |
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