Basic Information
Provider Information
NPI: 1114218450
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GERSCOVICH
FirstName: DANIEL
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: M.D
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2445 ARMY NAVY DR
Address2: ANDERSON ORTHOPAEDIC CLINIC
City: ARLINGTON
State: VA
PostalCode: 222062905
CountryCode: US
TelephoneNumber: 7038926500
FaxNumber: 7037698486
Practice Location
Address1: 2445 ARMY NAVY DR
Address2: ANDERSON CLINIC INC
City: ARLINGTON
State: VA
PostalCode: 222062905
CountryCode: US
TelephoneNumber: 7038926500
FaxNumber: 7037698486
Other Information
ProviderEnumerationDate: 04/20/2011
LastUpdateDate: 07/26/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207X00000X0101260361VAY Allopathic & Osteopathic PhysiciansOrthopaedic Surgery 

No ID Information.


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