Provider Demographics
NPI:1356476410
Name:GONZALES, MANUEL FALCON (MD)
Entity Type:Individual
Prefix:DR
First Name:MANUEL
Middle Name:FALCON
Last Name:GONZALES
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 1:6212 STONEHAM LN
Mailing Address - Street 2:
Mailing Address - City:MCLEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-2343
Mailing Address - Country:US
Mailing Address - Phone:703-442-9079
Mailing Address - Fax:
Practice Address - Street 1:1145 19TH ST NW
Practice Address - Street 2:SUITE 850
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036-3701
Practice Address - Country:US
Practice Address - Phone:202-223-9040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD 6405207L00000X, 207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Not Answered207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCC88799Medicare UPIN
DC413682Medicare ID - Type Unspecified