Provider Demographics
NPI:1790792539
Name:GLICK, BRIAN NEAL (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:NEAL
Last Name:GLICK
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:611 S CARLIN SPRINGS RD
Mailing Address - Street 2:SUITE 405
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22204-1087
Mailing Address - Country:US
Mailing Address - Phone:703-671-2490
Mailing Address - Fax:703-820-7207
Practice Address - Street 1:3022 WILLIAMS DR
Practice Address - Street 2:STE 300
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4600
Practice Address - Country:US
Practice Address - Phone:703-573-9800
Practice Address - Fax:703-573-2959
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2017-08-18
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Provider Licenses
StateLicense IDTaxonomies
VA0101049247207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6061001Medicaid
VA6061001Medicaid
DCGL734159Medicare PIN