Provider Demographics
NPI:1851312938
Name:WENDY R. GOTTLIEB, M.D.,P.L.C.
Entity Type:Organization
Organization Name:WENDY R. GOTTLIEB, M.D.,P.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:RUTH
Authorized Official - Last Name:GOTTLIEB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-668-9499
Mailing Address - Street 1:7244 EVANS MILL RD
Mailing Address - Street 2:
Mailing Address - City:MCLEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-3422
Mailing Address - Country:US
Mailing Address - Phone:703-356-6466
Mailing Address - Fax:703-689-4998
Practice Address - Street 1:1850 TOWN CENTER PKWY
Practice Address - Street 2:SUITE 301
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-3219
Practice Address - Country:US
Practice Address - Phone:703-668-9499
Practice Address - Fax:703-689-4998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA010121213174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAG01351W01Medicare PIN
VAH51211Medicare UPIN