Provider Demographics
NPI:1134180300
Name:GAUGAU, NORDINE (MD)
Entity type:Individual
Prefix:DR
First Name:NORDINE
Middle Name:
Last Name:GAUGAU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:NOURREDDINE
Other - Middle Name:
Other - Last Name:GUAOUGUAOU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:6723 WHITTIER AVE
Mailing Address - Street 2:STE 306
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-4533
Mailing Address - Country:US
Mailing Address - Phone:703-891-3147
Mailing Address - Fax:
Practice Address - Street 1:6723 WHITTIER AVE
Practice Address - Street 2:STE 306
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-4533
Practice Address - Country:US
Practice Address - Phone:703-891-3147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-29
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00639722085R0202X
MDD639722085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC2849OtherB/C B/S
MDKA80OtherB/C B/S
MDJ062OtherB/C B/S
MDCD4495Medicare ID - Type UnspecifiedRAILROAD MEDICARE
MDJ062OtherB/C B/S
MDKA80OtherB/C B/S
DC2849OtherB/C B/S
MDI48658Medicare UPIN
MD434LN316Medicare ID - Type UnspecifiedLOCALITY/JURIS. CODE 01
MD435LN315Medicare ID - Type UnspecifiedLOCALITY/JURIS. CODE 02