Healthcare Provider Details

I. General information

NPI: 1356995088
Provider Name (Legal Business Name): DANA GELB
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2019
Last Update Date: 08/13/2025
Certification Date: 08/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3541 W BRADDOCK RD STE 150
ALEXANDRIA VA
22302-1923
US

IV. Provider business mailing address

5848 WYE OAK COMMONS CT
BURKE VA
22015-2843
US

V. Phone/Fax

Practice location:
  • Phone: 703-574-0708
  • Fax:
Mailing address:
  • Phone: 703-638-9336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number0024177133
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: