Provider Demographics
NPI:1245486521
Name:NOWAK, GERALD J (DO)
Entity type:Individual
Prefix:
First Name:GERALD
Middle Name:J
Last Name:NOWAK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1412 OAKBROOKE AVE
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22308-1704
Mailing Address - Country:US
Mailing Address - Phone:703-765-9451
Mailing Address - Fax:
Practice Address - Street 1:1412 OAKBROOKE AVE
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22308-1704
Practice Address - Country:US
Practice Address - Phone:703-765-9451
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-18
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102036835207Q00000X
MI5101012928207Q00000X
DCDO31529207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine