Provider Demographics
NPI:1083795496
Name:MALGORZATA GRADZKA, M.D., P.C.
Entity Type:Organization
Organization Name:MALGORZATA GRADZKA, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MALGORZATA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRADZKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-648-9800
Mailing Address - Street 1:PO BOX 34
Mailing Address - Street 2:
Mailing Address - City:CABIN JOHN
Mailing Address - State:MD
Mailing Address - Zip Code:20818-0034
Mailing Address - Country:US
Mailing Address - Phone:703-648-9800
Mailing Address - Fax:703-648-9808
Practice Address - Street 1:3620 JOSEPH SIEWICK DR
Practice Address - Street 2:SUITE 401
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-1756
Practice Address - Country:US
Practice Address - Phone:703-648-9800
Practice Address - Fax:703-648-9808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2009-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101056754207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005853940Medicaid
VAG58003Medicare UPIN
VA000717Medicare PIN