Provider Demographics
NPI:1376724062
Name:GRADZKA, MALGORZATA (MD)
Entity Type:Individual
Prefix:DR
First Name:MALGORZATA
Middle Name:
Last Name:GRADZKA
Suffix:
Gender:F
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:PO BOX 34
Mailing Address - Street 2:
Mailing Address - City:CABIN JOHN
Mailing Address - State:MD
Mailing Address - Zip Code:20818-0034
Mailing Address - Country:US
Mailing Address - Phone:703-648-9800
Mailing Address - Fax:703-648-9808
Practice Address - Street 1:3620 JOSEPH SIEWICK DR
Practice Address - Street 2:SUITE 401
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-1756
Practice Address - Country:US
Practice Address - Phone:703-648-9800
Practice Address - Fax:703-648-9808
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-21
Last Update Date:2009-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101056754207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005853940Medicaid
VA271949OtherANTHEM BCBS
VA005853940Medicaid
VA271949OtherANTHEM BCBS