Provider Demographics
NPI:1821696139
Name:JENNIFER GORRELICK, MD, PLLC
Entity Type:Organization
Organization Name:JENNIFER GORRELICK, MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIANS
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:L
Authorized Official - Last Name:GORRELICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-349-7434
Mailing Address - Street 1:6625 IVY HILL DR
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-5207
Mailing Address - Country:US
Mailing Address - Phone:703-980-8993
Mailing Address - Fax:
Practice Address - Street 1:1800 TOWN CENTER DR STE 418
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-3240
Practice Address - Country:US
Practice Address - Phone:703-349-7434
Practice Address - Fax:703-382-8330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-09
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty