Provider Demographics
NPI:1043318942
Name:MA, ANN I (MD)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:I
Last Name:MA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224D CORNWALL ST NW
Mailing Address - Street 2:SUITE 207
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-2700
Mailing Address - Country:US
Mailing Address - Phone:703-771-9001
Mailing Address - Fax:703-771-9076
Practice Address - Street 1:224D CORNWALL ST NW
Practice Address - Street 2:SUITE 207
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-2700
Practice Address - Country:US
Practice Address - Phone:703-771-9001
Practice Address - Fax:703-771-9076
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101051491207RG0100X
MD00037326207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA203435OtherANTHEM BCBS
247336OtherUNITED HEALTHCARE MAMSI
F07586Medicare UPIN
247336OtherUNITED HEALTHCARE MAMSI