Provider Demographics
NPI:1760451702
Name:GADOL, JUDITH (MD)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:
Last Name:GADOL
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 1:8134 OLD KEENE MILL RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22152-1800
Mailing Address - Country:US
Mailing Address - Phone:703-451-6111
Mailing Address - Fax:703-451-6247
Practice Address - Street 1:8134 OLD KEENE MILL RD
Practice Address - Street 2:SUITE 300
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22152-1800
Practice Address - Country:US
Practice Address - Phone:703-451-6111
Practice Address - Fax:703-451-6247
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2009-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101030824207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA22280007OtherCARE FIRST
VA010140510Medicaid
VA22280007OtherCARE FIRST
VAC09123Medicare PIN
VA073059Medicare PIN
VA014931E59Medicare PIN