Provider Demographics
NPI:1952474306
Name:FAMILY MEDICINE IN FALLS CHURCH PC
Entity Type:Organization
Organization Name:FAMILY MEDICINE IN FALLS CHURCH PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:WALKER
Authorized Official - Last Name:THEISZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:703-533-7555
Mailing Address - Street 1:124 E BROAD ST STE A
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22046-4530
Mailing Address - Country:US
Mailing Address - Phone:703-533-7555
Mailing Address - Fax:703-533-7797
Practice Address - Street 1:124 E BROAD ST STE A
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22046-4530
Practice Address - Country:US
Practice Address - Phone:703-533-7555
Practice Address - Fax:703-533-7797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101102617207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty