Provider Demographics
NPI:1922025741
Name:ROBERT M. GORSEN M.D.,PHD.,P.C.
Entity Type:Organization
Organization Name:ROBERT M. GORSEN M.D.,PHD.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:M
Authorized Official - Last Name:GORSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-573-4700
Mailing Address - Street 1:3301 WOODBURN RD
Mailing Address - Street 2:SUITE 211
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-1229
Mailing Address - Country:US
Mailing Address - Phone:703-573-4700
Mailing Address - Fax:703-573-7922
Practice Address - Street 1:3301 WOODBURN RD
Practice Address - Street 2:SUITE 211
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-1229
Practice Address - Country:US
Practice Address - Phone:703-573-4700
Practice Address - Fax:703-573-7922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101042525207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA096463OtherANTHEM
VA18110001OtherBLUE CHOICE
VA4353845OtherAETNA
VA4353845OtherAETNA
VA=========OtherFIRST HEALTH/ GREAT WEST
VA=========OtherCHAMPUS/TRICARE/FIRST HEA
VA=========OtherFIRST HEALTH/ GREAT WEST
VA6319650001Medicare NSC
VA=========OtherCHAMPUS/TRICARE/FIRST HEA