Provider Demographics
NPI:1467485383
Name:GAUVIN, WALI (MD)
Entity type:Individual
Prefix:DR
First Name:WALI
Middle Name:
Last Name:GAUVIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:14130 NOBLEWOOD PLZ
Mailing Address - Street 2:SUITE 306
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22193-1464
Mailing Address - Country:US
Mailing Address - Phone:800-784-8590
Mailing Address - Fax:877-755-3396
Practice Address - Street 1:14130 NOBLEWOOD PLZ
Practice Address - Street 2:SUITE 306
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22193-1464
Practice Address - Country:US
Practice Address - Phone:800-784-8590
Practice Address - Fax:877-755-3396
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0067292174400000X, 2080P0202X
VA0101242065174400000X, 208000000X, 2080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
No174400000XOther Service ProvidersSpecialist
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD017057700Medicaid
VA015161604Medicaid