Provider Demographics
NPI:1356995088
Name:GELB, DANA
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:GELB
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5848 WYE OAK COMMONS CT
Mailing Address - Street 2:
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22015-2843
Mailing Address - Country:US
Mailing Address - Phone:703-638-9336
Mailing Address - Fax:
Practice Address - Street 1:14900 CONFERENCE CENTER DR STE 170
Practice Address - Street 2:
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20151-3877
Practice Address - Country:US
Practice Address - Phone:703-468-2740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-31
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024177133363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health