Provider Demographics
NPI:1457399230
Name:GORRELICK, JENNIFER (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:GORRELICK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3833 FAIRFAX DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22203-1772
Mailing Address - Country:US
Mailing Address - Phone:703-525-8863
Mailing Address - Fax:
Practice Address - Street 1:3833 FAIRFAX DR
Practice Address - Street 2:SUITE 200
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22203-1772
Practice Address - Country:US
Practice Address - Phone:703-525-8863
Practice Address - Fax:703-717-4489
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101231318207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAB750P61Medicare ID - Type Unspecified
VAH47421Medicare UPIN