MEDICARE: GABRIEL GLUCK MD PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician	0101028855	VA

General Provider Information

NPI Number	:	1205140324
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GABRIEL GLUCK MD PC

Provider Business Mailing Address
First Line	:	8702 SUDLEY RD
Second Line	:
City	:	MANASSAS
State	:	VA
Zip	:	20110-4405
Country	:	US
Telephone Number	:	703-361-3590
Fax Number	:	703-335-6891

Provider Business Practice Location Address
First Line	:	8702 SUDLEY RD
Second Line	:
City	:	MANASSAS
State	:	VA
Zip	:	20110-4405
Country	:	US
Telephone Number	:	703-361-3590
Fax Number	:	703-335-6891

Authorized Official
Title or Position	:	PRESIDENT
Name	:	GABRIEL GLUCK
Credential	:	MD
Telephone Number	:	703-361-3590

Provider Enumeration Date	:	07/30/2010
Last Update Date	:	07/30/2010

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