Provider Demographics
NPI:1750371803
Name:GORLE, VIJAYA LAKSHMI (MD)
Entity type:Individual
Prefix:DR
First Name:VIJAYA
Middle Name:LAKSHMI
Last Name:GORLE
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:4080 LAFAYETTE CENTER DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20151-1218
Mailing Address - Country:US
Mailing Address - Phone:703-961-1680
Mailing Address - Fax:703-961-1681
Practice Address - Street 1:4080 LAFAYETTE CENTER DR
Practice Address - Street 2:SUITE 110
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20151-1218
Practice Address - Country:US
Practice Address - Phone:703-961-1680
Practice Address - Fax:703-961-1681
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2008-03-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0101235079207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA007078D64Medicare PIN
DCG01990D01Medicare PIN
VAI02866Medicare UPIN