Provider Demographics
NPI:1205140324
Name:GABRIEL GLUCK MD PC
Entity type:Organization
Organization Name:GABRIEL GLUCK MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GABRIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GLUCK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-361-3590
Mailing Address - Street 1:8702 SUDLEY RD
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-4405
Mailing Address - Country:US
Mailing Address - Phone:703-361-3590
Mailing Address - Fax:703-335-6891
Practice Address - Street 1:8702 SUDLEY RD
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-4405
Practice Address - Country:US
Practice Address - Phone:703-361-3590
Practice Address - Fax:703-335-6891
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-30
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101028855207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAB62692Medicare UPIN
VA200000724Medicare PIN