Healthcare Provider Details

I. General information

NPI: 1861675985
Provider Name (Legal Business Name): EDWARD E GAHRES, MS, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2007
Last Update Date: 02/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5021 SEMINARY RD 109
ALEXANDRIA VA
22311-1994
US

IV. Provider business mailing address

5021 SEMINARY RD 109
ALEXANDRIA VA
22311-1994
US

V. Phone/Fax

Practice location:
  • Phone: 703-931-7515
  • Fax: 703-931-9524
Mailing address:
  • Phone: 703-931-7515
  • Fax: 703-931-9524

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number0101-013586
License Number StateVA

VIII. Authorized Official

Name: DR. EDWARD ELIAS GAHRES
Title or Position: OWNER
Credential: M.D.
Phone: 703-931-7515