Provider Demographics
NPI:1114999216
Name:WEIRICH, GORDON D (MD)
Entity Type:Individual
Prefix:DR
First Name:GORDON
Middle Name:D
Last Name:WEIRICH
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 1:110 KILN DR
Mailing Address - Street 2:
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22801
Mailing Address - Country:US
Mailing Address - Phone:540-433-7040
Mailing Address - Fax:
Practice Address - Street 1:1151 KEEZLETOWN RD
Practice Address - Street 2:SUITE 101
Practice Address - City:WEYERS CAVE
Practice Address - State:VA
Practice Address - Zip Code:24486-2337
Practice Address - Country:US
Practice Address - Phone:540-234-9241
Practice Address - Fax:540-234-9200
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2011-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101-034168207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1114999216Medicaid
VA005623057Medicaid
VA1114999216Medicaid
VA005623057Medicaid
080005634Medicare ID - Type Unspecified
080005634Medicare PIN
B08973Medicare UPIN