Provider Demographics
NPI:1548420623
Name:GLORIA DUDA, M.D., P.C.
Entity Type:Organization
Organization Name:GLORIA DUDA, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DUDA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-893-1111
Mailing Address - Street 1:6845 ELM ST
Mailing Address - Street 2:#708
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-6007
Mailing Address - Country:US
Mailing Address - Phone:703-893-1111
Mailing Address - Fax:
Practice Address - Street 1:6845 ELM ST
Practice Address - Street 2:#708
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-6007
Practice Address - Country:US
Practice Address - Phone:703-893-1111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-12
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
133591Medicare PIN
VAF33558Medicare UPIN