Healthcare Provider Details

I. General information

NPI: 1083795496
Provider Name (Legal Business Name): MALGORZATA GRADZKA, M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 11/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3620 JOSEPH SIEWICK DR SUITE 401
FAIRFAX VA
22033-1756
US

IV. Provider business mailing address

PO BOX 34
CABIN JOHN MD
20818-0034
US

V. Phone/Fax

Practice location:
  • Phone: 703-648-9800
  • Fax: 703-648-9808
Mailing address:
  • Phone: 703-648-9800
  • Fax: 703-648-9808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number0101056754
License Number StateVA

VIII. Authorized Official

Name: DR. MALGORZATA GRADZKA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 703-648-9800