Healthcare Provider Details

I. General information

NPI: 1114218450
Provider Name (Legal Business Name): DANIEL GERSCOVICH M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2011
Last Update Date: 07/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2445 ARMY NAVY DR ANDERSON CLINIC INC
ARLINGTON VA
22206-2905
US

IV. Provider business mailing address

2445 ARMY NAVY DR ANDERSON ORTHOPAEDIC CLINIC
ARLINGTON VA
22206-2905
US

V. Phone/Fax

Practice location:
  • Phone: 703-892-6500
  • Fax: 703-769-8486
Mailing address:
  • Phone: 703-892-6500
  • Fax: 703-769-8486

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number0101260361
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: