| Organization Name: | NMG AFFILIATE PRACTICE I, LLC |
| NPI Number: | 1194110445 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | GEOFFREY K GARDNER (VP OF FINANCE) |
| Mailing Address: | 15195 Heathcote Blvd Suite 104 Haymarket |
| State: | VA US |
| Postal Code: | 201696242 |
| Phone Number: | 5712844370 |
| Fax Number: | 5712613278 |
| NPI Enumeration Date: | 04/03/2015 |
| NPI Last Update Date: | 10/07/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 207RC0000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Internal Medicine |
| Taxonomy Specialization: | Cardiovascular Disease |
| Taxonomy Definition: | An internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threatening, abnormal heartbeat rhythms. |