Provider Demographics
NPI:1437112521
Name:GURDZIEL, GLORIA KREIS (MD)
Entity Type:Individual
Prefix:MRS
First Name:GLORIA
Middle Name:KREIS
Last Name:GURDZIEL
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 1:3076 BRICKHOUSE CT
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452
Mailing Address - Country:US
Mailing Address - Phone:757-340-7489
Mailing Address - Fax:757-340-7518
Practice Address - Street 1:3076 BRICKHOUSE CT
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452
Practice Address - Country:US
Practice Address - Phone:757-340-7489
Practice Address - Fax:757-340-7518
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-10
Last Update Date:2009-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010379912084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA007100370Medicaid
059063OtherANTHEM
1568031OtherUBH
B06239Medicare UPIN
VA007100370Medicaid