Healthcare Provider Details

I. General information

NPI: 1518790419
Provider Name (Legal Business Name): GARY M. KORITZINSKY, M.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2024
Last Update Date: 08/26/2024
Certification Date: 08/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2021 K ST NW STE 520
WASHINGTON DC
20006-1003
US

IV. Provider business mailing address

2021 K ST NW STE 520
WASHINGTON DC
20006-1003
US

V. Phone/Fax

Practice location:
  • Phone: 202-466-4016
  • Fax: 202-293-4118
Mailing address:
  • Phone: 202-466-4016
  • Fax: 202-293-4118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: GARY M KORITZINSKY
Title or Position: OWNER
Credential: MD
Phone: 202-466-4016