Provider Demographics
NPI:1285851303
Name:GORSEN, ROBERT M (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:M
Last Name:GORSEN
Suffix:
Gender:M
Credentials:MD, PHD
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Other - Credentials:
Mailing Address - Street 1:3301 WOODBURN RD
Mailing Address - Street 2:SUITE 211
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-1229
Mailing Address - Country:US
Mailing Address - Phone:703-573-4700
Mailing Address - Fax:703-573-7922
Practice Address - Street 1:3301 WOODBURN RD
Practice Address - Street 2:SUITE 211
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-1229
Practice Address - Country:US
Practice Address - Phone:703-573-4700
Practice Address - Fax:703-573-7922
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101042525207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
541601192OtherTAX ID
C89306Medicare UPIN
VA6319650001Medicare NSC
G0529157Medicare ID - Type Unspecified