Provider Demographics
NPI:1245254069
Name:GARSON, RONALD JAY (MD)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:JAY
Last Name:GARSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12704 TAUSTIN LN
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-2978
Mailing Address - Country:US
Mailing Address - Phone:703-435-2388
Mailing Address - Fax:
Practice Address - Street 1:6 PIDGEON HILL DR
Practice Address - Street 2:# 260
Practice Address - City:STERLING
Practice Address - State:VA
Practice Address - Zip Code:20165-6146
Practice Address - Country:US
Practice Address - Phone:703-404-2135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101-0283242084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA203127OtherANTHEM BCBS
VA2620-0001OtherCAREFIRST BCBS
VA2620-0001OtherCAREFIRST BCBS