Healthcare Provider Details

I. General information

NPI: 1750386496
Provider Name (Legal Business Name): GARY KUGLER D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2005
Last Update Date: 08/21/2025
Certification Date: 08/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19440 GOLF VISTA PLAZA, SUITE 120
LEESBURG VA
20176-8272
US

IV. Provider business mailing address

224D CORNWALL ST NW
LEESBURG VA
20176-2713
US

V. Phone/Fax

Practice location:
  • Phone: 703-858-7887
  • Fax: 703-858-7453
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number0103000893
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: