Provider Demographics
NPI:1992810477
Name:LITOVITZ, GARY LANE (MD)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:LANE
Last Name:LITOVITZ
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 1:2110 GALLOWS RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3962
Mailing Address - Country:US
Mailing Address - Phone:703-883-2942
Mailing Address - Fax:703-821-8922
Practice Address - Street 1:2110 GALLOWS RD
Practice Address - Street 2:SUITE D
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-3962
Practice Address - Country:US
Practice Address - Phone:703-883-2942
Practice Address - Fax:703-821-8922
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010340242084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAB93463Medicare UPIN
VA114038Medicare ID - Type Unspecified