Provider Demographics
NPI:1124224514
Name:JAY C TYROLER M.D.,P.C.
Entity Type:Organization
Organization Name:JAY C TYROLER M.D.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL HOLDER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:CARY
Authorized Official - Last Name:TYROLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-264-0521
Mailing Address - Street 1:3620 JOSEPH SIEWICK DR
Mailing Address - Street 2:SUITE 306
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-1756
Mailing Address - Country:US
Mailing Address - Phone:703-264-0521
Mailing Address - Fax:703-860-0229
Practice Address - Street 1:3620 JOSEPH SIEWICK DR
Practice Address - Street 2:SUITE 306
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-1756
Practice Address - Country:US
Practice Address - Phone:703-264-0521
Practice Address - Fax:703-860-0229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-22
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101049092207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCG02817Medicare PIN