Provider Demographics
NPI:1811370869
Name:GURECKI, PHILIP (PA-C)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:
Last Name:GURECKI
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 THIMBLE SHOALS BLVD
Mailing Address - Street 2:SUITE 700
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-4544
Mailing Address - Country:US
Mailing Address - Phone:757-873-2000
Mailing Address - Fax:757-873-2003
Practice Address - Street 1:704 THIMBLE SHOALS BLVD
Practice Address - Street 2:SUITE 700
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-4544
Practice Address - Country:US
Practice Address - Phone:757-873-2000
Practice Address - Fax:757-873-2003
Is Sole Proprietor?:No
Enumeration Date:2015-07-08
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110004977363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1811370869Medicaid