Provider Demographics
NPI:1376518670
Name:FIALK, GARY S (MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:S
Last Name:FIALK
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:10301 DEMOCRACY LN
Mailing Address - Street 2:SUITE 410
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-2545
Mailing Address - Country:US
Mailing Address - Phone:703-876-5942
Mailing Address - Fax:703-876-5972
Practice Address - Street 1:1860 TOWN CENTER DR
Practice Address - Street 2:SUITE 180
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-5896
Practice Address - Country:US
Practice Address - Phone:703-689-3311
Practice Address - Fax:703-435-0137
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2013-12-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101053797174400000X
VA010153797208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA007502117Medicaid
VA852792Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
VA007502117Medicaid