Individual
DR. GARY S FIALK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1860 TOWN CENTER DR, SUITE 180, RESTON, VA 20190-5896
(703) 689-3311
(703) 435-0137
Mailing address
10301 DEMOCRACY LN, SUITE 410, FAIRFAX, VA 22030-2545
(703) 876-5942
(703) 876-5972
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
0101053797
VA
208800000X
Urology Physician
Primary
010153797
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
007502117
—
VA
Enumeration date
02/21/2006
Last updated
12/03/2013
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