Healthcare Provider Details

I. General information

NPI: 1588198691
Provider Name (Legal Business Name): MARY GASSER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2017
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 24TH ST
FORT LEE VA
23801-1716
US

IV. Provider business mailing address

700 24TH ST
FORT LEE VA
23801-1716
US

V. Phone/Fax

Practice location:
  • Phone: 804-734-9993
  • Fax: 877-874-1008
Mailing address:
  • Phone: 804-734-9993
  • Fax: 877-874-1008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101265660
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: