Provider Demographics
NPI:1679603385
Name:JOHN E GIBSON, M.D., JOSEPH H. KAUFMAN, M.D.,LTD
Entity Type:Organization
Organization Name:JOHN E GIBSON, M.D., JOSEPH H. KAUFMAN, M.D.,LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTOPHER
Authorized Official - Middle Name:JON
Authorized Official - Last Name:KAUFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-751-2616
Mailing Address - Street 1:5249 DUKE ST STE 5
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-2907
Mailing Address - Country:US
Mailing Address - Phone:703-751-2616
Mailing Address - Fax:703-370-8275
Practice Address - Street 1:5249 DUKE ST STE 5
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-2907
Practice Address - Country:US
Practice Address - Phone:703-751-2616
Practice Address - Fax:703-370-8275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101023946207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA076287OtherANTHEM GRP
VA5425110OtherAETNA GRP
DC169942OtherMEDICARE DC GRP
VACL7709OtherMEDICARE RR GRP
VA100152OtherKAISER
DC169942Medicare PIN