Individual
GORDON W THEISZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
825 FAIRFAX AVE # 118, NORFOLK, VA 23507-1912
(757) 446-5955
(757) 446-5196
Mailing address
825 FAIRFAX AVE # 118, NORFOLK, VA 23507-1914
(757) 446-5955
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0101102617
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010189781
—
VA
01
—
P00377886
RAILROAD MEDICARE
VA
Enumeration date
05/17/2006
Last updated
08/20/2025
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