Provider Demographics
NPI:1962544700
Name:TYROLER, JAY CARY (MD)
Entity type:Individual
Prefix:DR
First Name:JAY
Middle Name:CARY
Last Name:TYROLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9442 BRENNER CT
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22180-3402
Mailing Address - Country:US
Mailing Address - Phone:703-281-6844
Mailing Address - Fax:
Practice Address - Street 1:3650 JOSEPH SIEWICK DR
Practice Address - Street 2:SUITE 204
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-1710
Practice Address - Country:US
Practice Address - Phone:703-264-0521
Practice Address - Fax:703-860-0229
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101049092207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA110159387OtherRAILROAD MEDICARE
1474837OtherCIGNA
4154451OtherUNITED
VA504726OtherNCPPO
770675456OtherCOVENTRY
DC13780001OtherBCBS CAREFIRST
VA4311862OtherAETNA
770675456OtherPHCS
295383OtherANTHEM
VAC86857Medicare UPIN
VA4311862OtherAETNA
000K35J35Medicare PIN