MEDICARE: GERALD J NOWAK DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	0102036835	VA
2	207Q00000X	Family Medicine Physician	5101012928	MI
3	207Q00000X	Family Medicine Physician	DO31529	DC

General Provider Information

NPI Number	:	1245486521
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GERALD J NOWAK DO

Provider Business Mailing Address
First Line	:	1412 OAKBROOKE AVE
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22308-1704
Country	:	US
Telephone Number	:	703-765-9451
Fax Number	:

Provider Business Practice Location Address
First Line	:	1412 OAKBROOKE AVE
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22308-1704
Country	:	US
Telephone Number	:	703-765-9451
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/18/2008
Last Update Date	:	08/18/2008

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