Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 0101257854 | VA |
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | 0101257854 | VA |
N | 207XP3100X | Pediatric Orthopaedic Surgeon | MD043693 | DC |
NPI | 1013173004 |
---|---|
Provider Name | Dr. George Damon Gantsoudes |
First Address | Fairfax, VA 22031-2241 |
Second Address | Fairfax, VA 22031-2241 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/07/2008 |
Last Update Date | 16/04/2020 |